{"hospital_name": "VHS Acquisition Subsidiary Number 9 Inc", "last_updated_on": "2026-06-05", "version": "3.0.0", "pid": "1514637050", "rid": "13965", "location_name": ["MetroWest Medical Center - Framingham"], "hospital_address": ["115 Lincoln St, Framingham, MA 01702"], "type_2_npi": ["1740252592"], "license_information": {"license_number": "2020", "state": "MA"}, "attestation": {"attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Geoffrey Vines"}, "standard_charge_information": [{"description": "1 ADMN RSV MONOC ANTB IM NJX", "code_information": [{"code": "96381", "type": "CPT"}], "standard_charges": [{"minimum": 29.77, "maximum": 33.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4206", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 MED VISIT IN 24MO", "code_information": [{"code": "G9247", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 OR NO CT SINUS W/IN 90D DX", "code_information": [{"code": "G9354", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1 or more neuropsych", "code_information": [{"code": "G8947", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "100 INSULIN SYRINGES", "code_information": [{"code": "S8490", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "11-DEOXYXORTISL", "code_information": [{"code": "82634", "type": "CPT"}, {"code": "7252517", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 149.29, "gross_charge": 403.0, "discounted_cash": 302.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "17-HYDROXY PREGNENOLONE", "code_information": [{"code": "84143", "type": "CPT"}, {"code": "7258414", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 116.4, "gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 116.4, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.25, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "180 d implant glucose sensor", "code_information": [{"code": "G0308", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1>=risk or>= mod risk for te", "code_information": [{"code": "G8972", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS HIGH 75", "code_information": [{"code": "99223", "type": "CPT"}], "standard_charges": [{"minimum": 181.29, "maximum": 181.29, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 181.29, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 181.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 181.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 181.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 181.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS MODERATE 55", "code_information": [{"code": "99222", "type": "CPT"}], "standard_charges": [{"minimum": 123.54, "maximum": 123.54, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS SF/LOW 40", "code_information": [{"code": "99221", "type": "CPT"}], "standard_charges": [{"minimum": 89.3, "maximum": 89.3, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.3, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE HIGH MDM 50", "code_information": [{"code": "99306", "type": "CPT"}], "standard_charges": [{"minimum": 143.33, "maximum": 143.33, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 143.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 143.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 143.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 143.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 143.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE MODERATE MDM 35", "code_information": [{"code": "99305", "type": "CPT"}], "standard_charges": [{"minimum": 111.93, "maximum": 111.93, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE SF/LOW MDM 25", "code_information": [{"code": "99304", "type": "CPT"}], "standard_charges": [{"minimum": 80.86, "maximum": 80.86, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 80.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 80.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 80.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 80.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 80.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6694.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1st course antitnf", "code_information": [{"code": "G8868", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4207", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2+ ANTIPSY SCHIZ", "code_information": [{"code": "G0032", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2+ BENZO SEIZ", "code_information": [{"code": "G0033", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "20+ CC SYRINGE ONLY", "code_information": [{"code": "A4213", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.92, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,CO", "code_information": [{"code": "C8923", "type": "HCPCS"}], "standard_charges": [{"estimated_discounted_cash": 6383.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90650", "type": "CPT"}], "standard_charges": [{"minimum": 143.06, "maximum": 158.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 143.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 158.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 158.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 158.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 158.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4208", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "3 COMP FOOT EXAM COMPLETED", "code_information": [{"code": "G9226", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and 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"standard_charge_dollar": 488.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD AORTA W/BI LWR EXT", "code_information": [{"code": "75630", "type": "CPT"}, {"code": "4915631", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 2861.66, "gross_charge": 7573.0, "discounted_cash": 5679.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1590.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1416.22, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 488.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 488.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 488.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 488.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 488.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD AORTOGRPHY BY SERIAL", "code_information": [{"code": "75625", "type": "CPT"}, {"code": "4615627", "type": "CDM"}, {"code": 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schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD AORTOGRPHY BY SERIAL", "code_information": [{"code": "75625", "type": "CPT"}, {"code": "4915627", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 2861.66, "gross_charge": 12925.0, "discounted_cash": 9693.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2714.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1356.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 436.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 436.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 436.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 436.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 436.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD ART/VEN FLOW ABD COMP", "code_information": [{"code": "93975", "type": "CPT"}, {"code": "4630040", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 314.02, "maximum": 448.31, "gross_charge": 2644.0, "discounted_cash": 1983.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 448.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 323.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 314.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 448.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 448.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 448.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 448.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD ART/VEN FLOW ABD COMP", "code_information": [{"code": "93975", "type": "CPT"}, {"code": "5062015", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 314.02, "maximum": 448.31, "gross_charge": 750.0, "discounted_cash": 562.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 448.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 323.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 314.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 448.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 448.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 448.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 448.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD ART/VEN FLOW LTD", "code_information": [{"code": "93976", "type": "CPT"}, {"code": "4633976", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 153.23, "maximum": 256.63, "gross_charge": 3036.0, "discounted_cash": 2277.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 256.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 157.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 153.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 256.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 256.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 256.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 256.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD ART/VEN FLOW LTD", "code_information": [{"code": "93976", "type": "CPT"}, {"code": "5062017", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 153.23, "maximum": 256.63, "gross_charge": 3036.0, "discounted_cash": 2277.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 256.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 157.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 153.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 256.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 256.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 256.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 256.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6262.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGE", "code_information": [{"code": "4919083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5121.0, "discounted_cash": 3840.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGE", "code_information": [{"code": "5059083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5121.0, "discounted_cash": 3840.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGE", "code_information": [{"code": "5069083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5121.0, "discounted_cash": 3840.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4720.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABDOMEN 1 VIEW", "code_information": [{"code": "74018", "type": "CPT"}, {"code": "4904018", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 80.9, "gross_charge": 900.0, "discounted_cash": 675.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMEN 1 VIEW", "code_information": [{"code": "74018", "type": "CPT"}, {"code": "5014018", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 80.9, "gross_charge": 900.0, "discounted_cash": 675.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMEN 2 VIEWS", "code_information": [{"code": "74019", "type": "CPT"}, {"code": "4904019", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 181.44, "gross_charge": 864.0, "discounted_cash": 648.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 181.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMEN 2 VIEWS", "code_information": [{"code": "74019", "type": "CPT"}, {"code": "5014019", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 181.44, "gross_charge": 864.0, "discounted_cash": 648.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 181.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": 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"standard_charge_dollar": 54.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 54.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 54.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 54.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 54.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMEN 3/+ VIEWS", "code_information": [{"code": "74021", "type": "CPT"}, {"code": "4904021", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 181.44, "gross_charge": 864.0, "discounted_cash": 648.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 181.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMEN/CHEST DET FORBDY", "code_information": [{"code": "76010", "type": "CPT"}, {"code": "4904030", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 221.13, "gross_charge": 1053.0, "discounted_cash": 789.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 221.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.5, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMEN/CHEST DET FORBDY", "code_information": [{"code": "76010", "type": "CPT"}, {"code": "5014030", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 221.13, "gross_charge": 1053.0, "discounted_cash": 789.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 221.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.5, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.82, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMINAL FISTULA LK REP", "code_information": [{"code": "4914797", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6075.0, "discounted_cash": 4556.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ABG W CALC O2 SAT", "code_information": [{"code": "82803", "type": "CPT"}, {"code": "5501806", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 98.7, "gross_charge": 768.0, "discounted_cash": 576.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 98.7, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1235.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1235.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 607.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 607.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 607.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 607.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 607.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 895.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 895.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 895.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 895.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 895.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1939.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1939.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1939.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1939.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1939.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1628.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1628.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1628.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1628.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1628.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 683.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 683.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 683.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 683.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 683.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1846.1, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1846.1, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1846.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1846.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1846.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1480.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1480.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1480.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1480.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1480.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1612.27, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1612.27, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1612.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1612.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1612.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1626.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1626.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1626.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1626.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1626.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATION-AV NODE", "code_information": [{"code": "93650", "type": "CPT"}, {"code": "4610650", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "gross_charge": 9242.0, "discounted_cash": 6931.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1940.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 8937.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 8779.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 615.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7146.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6942.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 615.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 8779.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 615.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 615.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 615.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3410.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 6931.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 6931.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATN RENL TUMORS CRYO", "code_information": [{"code": "4910135", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 26061.0, "discounted_cash": 19545.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATN RENL TUMORS CRYO", "code_information": [{"code": "5050593", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17922.0, "discounted_cash": 13441.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.88, "maximum": 8.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 10287.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 371.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 371.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 371.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 371.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 371.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 402.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 402.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 402.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 402.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 402.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 539.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 539.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 539.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 539.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 539.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 413.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 413.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 413.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 413.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 413.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.77, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.77, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 570.48, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 570.48, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 570.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 570.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 570.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [{"code": "770", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1715.42, "maximum": 56476.96, "estimated_discounted_cash": 68381.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10301.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4156.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8464.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15758.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24961.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 50828.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2624.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1715.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26265.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16581.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 53483.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2761.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1804.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8906.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4373.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10839.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4619.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11445.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17509.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9405.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1906.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2916.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 56476.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27735.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27735.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2916.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1906.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9405.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4619.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11445.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17509.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 56476.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4619.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9405.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11445.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1906.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2916.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 56476.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27735.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17509.29, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 2837.46, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16012.39, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7029.07, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4158.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33291.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41951.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION WITHOUT D&C", "code_information": [{"code": "779", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27932.84, "maximum": 35199.15, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27932.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35199.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABOVE KNEE SURGICAL STOCKING", "code_information": [{"code": "A4490", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACAMPROSATE 333MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300025", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ACAMPROSATE 333MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300025", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACE/ARB NOT RX'D; DOC REAS", "code_information": [{"code": "G8474", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY NOT RX'D", "code_information": [{"code": "G8475", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACE/ARB THXPY RX'D", "code_information": [{"code": "G8473", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACETABULR COMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8131000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3556.35, "maximum": 3556.35, "gross_charge": 16935.0, "discounted_cash": 12701.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3556.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMID 500MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300102", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETAZOLAMID 500MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300102", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETAZOLAMIDE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300098", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETAZOLAMIDE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300098", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETONE QUALITATIVE", "code_information": [{"code": "82009", "type": "CPT"}, {"code": "4102007", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 23.03, "gross_charge": 69.0, "discounted_cash": 51.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETONE QUALITATIVE/2", "code_information": [{"code": "82009", "type": "CPT"}, {"code": "4102009", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 23.03, "gross_charge": 69.0, "discounted_cash": 51.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETONE QUANTITATIVE", "code_information": [{"code": "82010", "type": "CPT"}, {"code": "7252010", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 41.68, "gross_charge": 246.0, "discounted_cash": 184.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETONE QUANTITATIVE/2", "code_information": [{"code": "82010", "type": "CPT"}, {"code": "7252015", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 41.68, "gross_charge": 181.0, "discounted_cash": 135.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETONE QUANTITATIVE/3", "code_information": [{"code": "82010", "type": "CPT"}, {"code": "4102012", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 41.68, "gross_charge": 459.0, "discounted_cash": 344.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLINESTERASE ASSAY", "code_information": [{"code": "82013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 56.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 56.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.61, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN BINDING AB", "code_information": [{"code": "86041", "type": "CPT"}, {"code": "7250514", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "gross_charge": 97.0, "discounted_cash": 72.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN BLOCKING AB", "code_information": [{"code": "86042", "type": "CPT"}, {"code": "7250515", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "gross_charge": 97.0, "discounted_cash": 72.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7608", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.79, "maximum": 8.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACHR ANTIBODY/2", "code_information": [{"code": "83519", "type": "CPT"}, {"code": "7253581", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.91, "gross_charge": 106.0, "discounted_cash": 79.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACHR ANTIBODY/3", "code_information": [{"code": "83519", "type": "CPT"}, {"code": "7258385", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.91, "gross_charge": 106.0, "discounted_cash": 79.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.88, "methodology": "fee 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ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 155.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 155.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 155.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 155.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 155.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM 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43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACROMIOCLAVICULAR JTS BI", "code_information": [{"code": "73050", "type": "CPT"}, {"code": "4903050", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 258.93, "gross_charge": 1233.0, "discounted_cash": 924.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 258.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 87.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACROMIOCLAVICULAR JTS BI", "code_information": [{"code": "73050", "type": "CPT"}, {"code": "5013050", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 258.93, "gross_charge": 1233.0, "discounted_cash": 924.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 258.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 87.81, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH", "code_information": [{"code": "82024", "type": "CPT"}, {"code": "7252024", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 196.99, "gross_charge": 811.0, "discounted_cash": 608.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 196.99, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 53.97, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 53.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 53.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 53.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 53.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 166.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 166.29, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.56, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 443.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 443.33, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 121.46, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 121.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 121.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 121.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 121.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTH 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19324.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13280.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36233.85, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 24686.53, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6486.36, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11600.31, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7857.47, "methodology": "case rate"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYCLOVIR 200MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300160", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ACYCLOVIR 200MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300160", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", 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"code_information": [{"code": "97155", "type": "CPT"}], "standard_charges": [{"minimum": 45.46, "maximum": 51.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 45.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTIVE BEHAVIOR TX BY TECH", "code_information": [{"code": "97153", "type": "CPT"}], "standard_charges": [{"minimum": 45.46, "maximum": 51.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 45.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTOR HUMERAL CONN DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013172", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 134.19, "maximum": 134.19, "gross_charge": 639.0, "discounted_cash": 479.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 134.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITIVE FOR ENTERAL FORMULA", "code_information": [{"code": "B4104", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 0.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOSINE DEAMINASE", "code_information": [{"code": "84311", "type": "CPT"}, {"code": "7256367", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.66, "gross_charge": 229.0, "discounted_cash": 171.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 35.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AB", "code_information": [{"code": "86603", "type": "CPT"}, {"code": "7256911", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.63, "gross_charge": 150.0, "discounted_cash": 112.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.63, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG DFA", "code_information": [{"code": "87260", "type": "CPT"}, {"code": "7252028", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 71.0, "discounted_cash": 53.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.21, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 7", "code_information": [{"code": "90477", "type": "CPT"}], "standard_charges": [{"minimum": 34.2, "maximum": 38.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADHERE TX ASSESS AT LST ANN", "code_information": [{"code": "G8851", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 859.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 859.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 859.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 859.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 859.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADHESIVE BANDAGE, FIRST-AID", "code_information": [{"code": "A6413", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJUSTABLE CHAIR FOR ESRD PT", "code_information": [{"code": "E1570", "type": "HCPCS"}], "standard_charges": [{"minimum": 754.13, "maximum": 862.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 776.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 754.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 862.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 862.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 862.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJUSTMENT GASTRIC BAND", "code_information": [{"code": "S2083", "type": "HCPCS"}], "standard_charges": [{"minimum": 4200.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADLT DISP UND/PULL ON ABV XL", "code_information": [{"code": "T4544", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV CHEMO 1ST HOME VISIT", "code_information": [{"code": "G0090", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV DRUG 1ST HOME VISIT", "code_information": [{"code": "G0088", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM SUBQ DRUG 1ST HOME VISIT", "code_information": [{"code": "G0089", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "1990028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2000028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2150028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2160028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2310028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2350028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2500028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "1990027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2000027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2150027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2160027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2310027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2350027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2500027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMN RSV MONOC ANTB IM CNSL", "code_information": [{"code": "96380", "type": "CPT"}], "standard_charges": [{"minimum": 34.56, "maximum": 38.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 38.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMN SARSCOV2 VACC 1 DOSE", "code_information": [{"code": "90480", "type": "CPT"}], "standard_charges": [{"minimum": 41.29, "maximum": 45.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 41.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADOPTIVE IMMUNOTHERAPY", "code_information": [{"code": "S2107", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC", "code_information": [{"code": "614", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16698.15, "maximum": 106930.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16698.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 73827.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 96236.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 40562.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17570.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 101263.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 42680.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 77684.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 45069.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 82031.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18553.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 106930.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18553.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 82031.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 45069.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 106930.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 45069.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18553.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 106930.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 82031.81, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 91414.39, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 32046.96, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 17611.8, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 71986.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 72772.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 91702.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "615", "type": "MS-DRG"}], "standard_charges": [{"minimum": 46459.56, "maximum": 58545.31, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46459.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 58545.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL IMG CORTX/MEDULA", "code_information": [{"code": "78075", "type": "CPT"}, {"code": "5208075", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1362.06, "gross_charge": 6486.0, "discounted_cash": 4864.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1362.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 551.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 433.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 433.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 433.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 433.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 433.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL TISSUE TRANSPLANT", "code_information": [{"code": "S2103", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}], "standard_charges": [{"minimum": 1305.37, "maximum": 1305.37, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADULT COMPANIONCARE PER 15M", "code_information": [{"code": "S5135", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT COMPANIONCARE PER DIEM", "code_information": [{"code": "S5136", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAY CARE PER DIEM", "code_information": [{"code": "S5102", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAY CARE PER HALF DAY", "code_information": [{"code": "S5101", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT DAYCARE SERVICES 15MIN", "code_information": [{"code": "S5100", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", 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"billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER SM", "code_information": [{"code": "T4521", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER XL", "code_information": [{"code": "T4524", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON LG", 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"gross_charge": 1034.0, "discounted_cash": 775.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 260.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AEROSOL TREATMENT", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "6704641", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 16.25, "maximum": 298.43, "gross_charge": 1034.0, "discounted_cash": 775.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 260.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}], "standard_charges": [{"minimum": 3232.49, "maximum": 3591.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3232.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3591.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3591.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3591.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3591.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLIBERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0178", "type": "HCPCS"}], "standard_charges": [{"minimum": 694.4, "maximum": 771.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 694.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 771.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 771.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 771.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 771.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLURIA VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2035", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.42, "maximum": 18.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFP FRACTION AND TOTAL", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "7258210", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 328.46, "gross_charge": 1357.0, "discounted_cash": 1017.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 328.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.99, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFTER CATARACT LASER SURGERY", "code_information": [{"code": "66821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL 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billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITH CC/MCC", "code_information": [{"code": "949", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39500.42, "maximum": 49775.86, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39500.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49775.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITHOUT CC/MCC", "code_information": [{"code": "950", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15380.97, "maximum": 113109.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36850.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 101797.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH 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"plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30123.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 113109.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 61995.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 61995.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30123.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 113109.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40945.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 113109.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40945.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 61995.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30123.32, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 21969.09, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 34975.74, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 75468.53, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 15380.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20840.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26262.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "560", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7031.68, "maximum": 47114.9, "estimated_discounted_cash": 76197.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14947.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7137.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10614.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8150.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11168.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7509.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8575.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15727.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9055.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11793.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16607.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7930.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9055.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16607.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7930.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11793.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7930.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11793.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16607.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9055.79, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 14064.66, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7887.48, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7031.68, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10098.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37388.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47114.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "559", "type": "MS-DRG"}], "standard_charges": [{"minimum": 61918.41, "maximum": 78025.55, "estimated_discounted_cash": 119009.06, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 61918.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 78025.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "561", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4151.17, "maximum": 33634.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7611.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25157.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11906.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH 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"standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE", "code_information": [{"code": "82088", "type": "CPT"}, {"code": "7252087", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 207.83, "gross_charge": 693.0, "discounted_cash": 519.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 207.83, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 56.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 56.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 56.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 56.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 56.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 40.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 639.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 639.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 175.34, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 175.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 175.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 175.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 175.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE/2", "code_information": [{"code": "82088", "type": "CPT"}, {"code": "7252089", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 207.83, "gross_charge": 234.0, "discounted_cash": 175.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 207.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 56.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 56.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 56.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 56.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 56.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 40.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALEFACEPT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0215", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.48, "maximum": 41.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 41.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 41.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 41.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 41.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALGLUCERASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0205", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.83, "maximum": 42.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37.83, "methodology": "fee 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HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITH MCC", "code_information": [{"code": "915", "type": "MS-DRG"}], "standard_charges": [{"minimum": 55832.48, "maximum": 70356.46, "estimated_discounted_cash": 86171.07, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55832.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 70356.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [{"code": "916", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22122.49, "maximum": 27877.33, "estimated_discounted_cash": 22920.59, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22122.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27877.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLERGY PATCH TESTS", "code_information": [{"code": "95044", "type": "CPT"}], "standard_charges": [{"minimum": 8.58, "maximum": 68.55, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 61.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO 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"standard_charge_dollar": 8.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGY/IMMUNOLOGY SS", "code_information": [{"code": "G0060", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1262.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1262.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1262.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1262.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1262.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLODERM 16X20CM PRF SQ CM IMP", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "4027025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 72.03, "maximum": 72.03, "gross_charge": 343.0, "discounted_cash": 257.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 72.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLODERM PER SQ CM (IMPLANT)", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "4020486", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 48.93, "maximum": 48.93, "gross_charge": 233.0, "discounted_cash": 174.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 48.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLODERM PER SQ CM (SKIN SUB)", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "4020485", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 13370.07, "maximum": 13370.07, "gross_charge": 63667.0, "discounted_cash": 47750.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 13370.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLODERM PER SQ CM (SKIN SUB)", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "4020485", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 13370.07, "maximum": 13370.07, "gross_charge": 63667.0, "discounted_cash": 47750.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 13370.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [{"code": "14", "type": "MS-DRG"}], "standard_charges": [{"minimum": 399018.32, "maximum": 502816.92, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 399018.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 502816.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT AMNIOTIC MEMBRN", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4027054", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 4764.27, "maximum": 4764.27, "gross_charge": 22687.0, "discounted_cash": 17015.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4764.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT AMNIOTIC MEMBRN", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4027054", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4764.27, "maximum": 4764.27, "gross_charge": 22687.0, "discounted_cash": 17015.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4764.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT CANCELLOUS PARTICUL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 378.0, "gross_charge": 1800.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}], "billing_class": 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{"description": "AMMONIA", "code_information": [{"code": "82140", "type": "CPT"}, {"code": "4102140", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.31, "gross_charge": 256.0, "discounted_cash": 192.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIO OR BIODMATRIX, INJ 1CC", "code_information": [{"code": "Q4139", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO THERAPEUTIC", "code_information": [{"code": "5069001", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5124.0, "discounted_cash": 3843.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS DIAG", "code_information": [{"code": "5061145", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1755.0, "discounted_cash": 1316.25, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS DIAGNOSTIC", "code_information": [{"code": "59000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 70.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 70.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 70.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 70.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 70.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS THERAPEUTIC", "code_information": [{"code": "59001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOEXCEL BIODEXCEL 1SQ CM", "code_information": [{"code": "Q4137", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIOTIC FLUID SCAN", "code_information": [{"code": "82143", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 35.08, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOTIC MEMBRANE", "code_information": [{"code": "V2790", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOX W/WO CLAV RX", "code_information": [{"code": "G9315", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOXIC NOT PRESC AS 1ST LINE", "code_information": [{"code": "G9313", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMOXIC/CLAV200/5 5MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314225", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXIC/CLAV200/5 5MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314225", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXIC/CLAV250/5 5MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314237", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXIC/CLAV250/5 5MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314237", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXIC/CLAV600/5 5MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314243", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXIC/CLAV600/5 5MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314243", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXIC/CLAV600/5 75PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314238", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXIC/CLAV600/5 75PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314238", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN 125/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314249", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN 125/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314249", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN 250/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314253", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN 250/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314253", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300723", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300723", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN 500MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300725", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN 500MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300725", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN/CLAV 250MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300712", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN/CLAV 250MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300712", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN/CLAV 500MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300715", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN/CLAV 500MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300715", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN/CLAV 875MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300713", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLIN/CLAV 875MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300713", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLN 400/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314258", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILLN 400/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314258", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILN 125/5 100ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314251", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILN 125/5 100ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314251", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILN 250/5 100ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314254", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILN 250/5 100ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314254", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILN 400/5 100ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314246", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AMOXICILN 400/5 100ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314246", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AMP CYCLIC", "code_information": [{"code": "82030", "type": "CPT"}, {"code": "7252030", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 131.58, "gross_charge": 561.0, "discounted_cash": 420.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 131.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.05, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHET/DEXAMPHET 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327112", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPHET/DEXAMPHET 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327112", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPHETAM MIX 10MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327021", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPHETAM MIX 10MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327021", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPHETAM MIX 5MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327018", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPHETAM MIX 5MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327018", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPHETAMINE QUAN 1-2/2", "code_information": [{"code": "80324", "type": "CPT"}, {"code": "7252145", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 928.0, "discounted_cash": 696.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 3OR 4", "code_information": [{"code": "80325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 5+", "code_information": [{"code": "80326", "type": "CPT"}, {"code": "7250326", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 1286.0, "discounted_cash": 964.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHO B CHOLESTERYL SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0288", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.6, "maximum": 14.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHOT B LIPOS PER10MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0289", "type": "HCPCS"}, {"code": "5318251", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 19.33, "maximum": 21.48, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHOT B LIPOS PER10MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0289", "type": "HCPCS"}, {"code": "5318251", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 19.33, "maximum": 21.48, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPID COMPLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0287", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.27, "maximum": 10.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN 500MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300750", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPICILLIN 500MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300750", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 677.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 677.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 677.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 677.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 677.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 800.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 800.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 800.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 800.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 800.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 900.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 900.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 900.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 900.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 900.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 681.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 681.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 681.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 681.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 681.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LOWER LEG AT KNEE", "code_information": [{"code": "27598", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 732.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 732.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 732.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 732.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 732.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE METACARPAL BONE", "code_information": [{"code": "26910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE UPPER ARM & IMPLANT", "code_information": [{"code": "24931", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.29, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.29, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24925", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 725.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 725.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 725.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 725.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 725.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25907", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25909", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 785.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 785.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 785.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 785.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 785.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25924", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 663.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 663.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 663.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 663.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 663.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25929", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25931", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27594", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27884", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27886", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.15, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.15, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [{"code": "240", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8447.14, "maximum": 119262.07, "estimated_discounted_cash": 130062.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15512.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21153.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34772.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13420.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22258.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16322.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36588.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14121.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14912.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38636.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17235.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23504.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17235.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23504.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14912.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38636.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38636.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17235.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14912.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23504.48, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 14701.29, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9510.37, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8447.14, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 29088.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 94642.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 119262.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [{"code": "239", "type": "MS-DRG"}], "standard_charges": [{"minimum": 163410.28, "maximum": 205919.01, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 163410.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 205919.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC", "code_information": [{"code": "241", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5740.14, "maximum": 57921.91, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11346.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14124.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20588.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 40100.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14862.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 42195.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11939.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21664.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15693.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12607.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 44557.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 22876.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15693.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12607.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 44557.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 22876.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15693.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12607.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 22876.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 44557.06, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 28112.35, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 12325.65, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7549.59, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5740.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 45964.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 57921.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "475", "type": "MS-DRG"}], "standard_charges": [{"minimum": 75557.79, "maximum": 95213.01, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 75557.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 95213.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "474", "type": "MS-DRG"}], "standard_charges": [{"minimum": 142532.87, "maximum": 179610.64, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 142532.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 179610.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "476", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39185.0, "maximum": 49378.39, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39185.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49378.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FINGER/THUMB", "code_information": [{"code": "26951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FINGER/THUMB", "code_information": [{"code": "26952", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27888", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 705.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 705.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 705.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 705.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 705.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27889", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.59, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 788.64, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 788.64, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 788.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 788.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 788.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1253.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1253.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1253.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1253.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1253.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF HAND", "code_information": [{"code": "25927", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 812.78, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 812.78, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 812.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 812.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 812.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1538.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1538.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1538.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1538.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1538.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1236.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1236.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1236.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1236.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1236.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27881", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 888.18, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 888.18, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 888.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 888.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 888.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 631.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 631.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 631.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 631.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 631.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [{"code": "617", "type": "MS-DRG"}], "standard_charges": [{"minimum": 62097.7, "maximum": 78251.48, "estimated_discounted_cash": 113845.07, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 62097.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 78251.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [{"code": "616", "type": "MS-DRG"}], "standard_charges": [{"minimum": 115788.65, "maximum": 145909.33, "estimated_discounted_cash": 129847.03, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 115788.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 145909.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "618", "type": "MS-DRG"}], "standard_charges": [{"minimum": 47090.4, "maximum": 59340.25, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47090.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 59340.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF MIDFOOT", "code_information": [{"code": "28800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 578.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 578.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 578.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 578.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 578.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF TOE", "code_information": [{"code": "28820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17673.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 698.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 698.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 698.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 698.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 698.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 689.1, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 689.1, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 689.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 689.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 689.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION THRU METATARSAL", "code_information": [{"code": "28805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 36844.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION TOE & METATARSAL", "code_information": [{"code": "28810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 25428.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMYLASE", "code_information": [{"code": "82150", "type": "CPT"}, {"code": "4102150", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.07, "gross_charge": 191.0, "discounted_cash": 143.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.07, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMYLASE", "code_information": [{"code": "82150", "type": "CPT"}, {"code": "7252150", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.07, "gross_charge": 221.0, "discounted_cash": 165.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMYLASE/2", "code_information": [{"code": "82150", "type": "CPT"}, {"code": "7252151", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.07, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.07, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMYLASE/4", "code_information": [{"code": "82150", "type": "CPT"}, {"code": "7252153", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.07, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.07, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMYLASE/5", "code_information": [{"code": "82150", "type": "CPT"}, {"code": "4102154", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.07, "gross_charge": 191.0, "discounted_cash": 143.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.06, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15535.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39700.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15535.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10971.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39700.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 22316.97, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA 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[{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 3-5", "code_information": [{"code": "80330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NONOPIOD 1-2", "code_information": [{"code": "80329", "type": "CPT"}, {"code": "7250290", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 850.0, "discounted_cash": 637.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NONOPIOD 6+", "code_information": [{"code": "80331", "type": "CPT"}, {"code": "7250384", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 1183.0, "discounted_cash": 887.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYS NEUROSTIM GEN PROG SMPL", "code_information": [{"code": "95976", "type": "CPT"}, {"code": "4805976", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "gross_charge": 1458.0, "discounted_cash": 1093.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYS NEUROSTM GEN PROG CMPLX", "code_information": [{"code": "95977", "type": "CPT"}, {"code": "4805977", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 160.08, "maximum": 183.07, "gross_charge": 841.0, "discounted_cash": 630.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 164.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 160.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYSIS NERVE", "code_information": [{"code": "88356", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 514.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 514.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 328.36, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 328.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 328.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 328.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 328.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYSIS TUMOR", "code_information": [{"code": "88358", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 88.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 82.18, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 82.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 82.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 82.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 82.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYZE SP INF PUMP W/REPROG", "code_information": [{"code": "62368", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14978.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALYZE SPINE INFUS PUMP", "code_information": [{"code": "62367", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAPLSMA PHGCYTOPHLM AMP PRB", "code_information": [{"code": "87468", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 35.09, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANASTOMOSIS/ARTERY-AORTA", "code_information": [{"code": "33606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1792.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1792.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1792.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1792.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1792.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANASTROZOLE 1 MG", "code_information": [{"code": "S0170", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANASTROZOLE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300762", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANASTROZOLE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300762", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCA SCREEN EACH ANTIBODY", "code_information": [{"code": "86036", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCA TITER EACH ANTIBODY", "code_information": [{"code": "86037", "type": "CPT"}, {"code": "7250245", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "gross_charge": 75.0, "discounted_cash": 56.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH BIO-SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4020598", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 602.49, "maximum": 602.49, "gross_charge": 2869.0, "discounted_cash": 2151.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 602.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH CORKSCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4020600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.71, "maximum": 346.71, "gross_charge": 1651.0, "discounted_cash": 1238.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 346.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH FASTAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8170070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 459.48, "maximum": 459.48, "gross_charge": 2188.0, "discounted_cash": 1641.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 459.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH HEALIX PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4020640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1915.2, "maximum": 1915.2, "gross_charge": 9120.0, "discounted_cash": 6840.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1915.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH QUICK MITEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8176200", "type": "CDM"}], "standard_charges": [{"minimum": 909.72, "maximum": 909.72, "gross_charge": 4332.0, "discounted_cash": 3249.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 909.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT ALL Q-FIX 1.8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 330.33, "maximum": 330.33, "gross_charge": 1573.0, "discounted_cash": 1179.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 330.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT ALL Q-FIX 2.8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010723", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 818.58, "maximum": 818.58, "gross_charge": 3898.0, "discounted_cash": 2923.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 818.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT ALLTHREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 337.47, "maximum": 337.47, "gross_charge": 1607.0, "discounted_cash": 1205.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 337.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT BIO-SUTURETAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4020700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 489.72, "maximum": 489.72, "gross_charge": 2332.0, "discounted_cash": 1749.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 489.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT BIOCRKSCRW FT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 389.13, "maximum": 389.13, "gross_charge": 1853.0, "discounted_cash": 1389.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 389.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT BIOSUTK SM JNT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 444.78, "maximum": 444.78, "gross_charge": 2118.0, "discounted_cash": 1588.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 444.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT FBRTAK W/SUTRTP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010721", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 205.38, "maximum": 205.38, "gross_charge": 978.0, "discounted_cash": 733.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 205.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT HEALIX ADVNC BR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 459.48, "maximum": 459.48, "gross_charge": 2188.0, "discounted_cash": 1641.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 459.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT INTELL FRC FIBR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 260.82, "maximum": 260.82, "gross_charge": 1242.0, "discounted_cash": 931.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 260.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT KNOTLESS FIBERTAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 528.36, "maximum": 528.36, "gross_charge": 2516.0, "discounted_cash": 1887.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 528.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT MINI BIOCOMPSTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "gross_charge": 2581.0, "discounted_cash": 1935.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 542.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT SHORT SFT W/NDL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 358.26, "maximum": 358.26, "gross_charge": 1706.0, "discounted_cash": 1279.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 358.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT SWVLCK PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 542.64, "maximum": 542.64, "gross_charge": 2584.0, "discounted_cash": 1938.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 542.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUT TWINFIX TITAN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 305.13, "maximum": 305.13, "gross_charge": 1453.0, "discounted_cash": 1089.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 305.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH SUTURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8170090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3005.1, "maximum": 3005.1, "gross_charge": 14310.0, "discounted_cash": 10732.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3005.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TIS/BN10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240023", "type": "CDM"}], "standard_charges": [{"minimum": 844.2, "maximum": 844.2, "gross_charge": 4020.0, "discounted_cash": 3015.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 844.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TIS/BN11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240025", "type": "CDM"}], "standard_charges": [{"minimum": 237.93, "maximum": 237.93, "gross_charge": 1133.0, "discounted_cash": 849.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 237.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240005", "type": "CDM"}], "standard_charges": [{"minimum": 39.06, "maximum": 39.06, "gross_charge": 186.0, "discounted_cash": 139.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 39.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240006", "type": "CDM"}], "standard_charges": [{"minimum": 68.88, "maximum": 68.88, "gross_charge": 328.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 68.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240016", "type": "CDM"}], "standard_charges": [{"minimum": 429.24, "maximum": 429.24, "gross_charge": 2044.0, "discounted_cash": 1533.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 429.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240017", "type": "CDM"}], "standard_charges": [{"minimum": 543.9, "maximum": 543.9, "gross_charge": 2590.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 543.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240018", "type": "CDM"}], "standard_charges": [{"minimum": 27.09, "maximum": 27.09, "gross_charge": 129.0, "discounted_cash": 96.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 27.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN9", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240021", "type": "CDM"}], "standard_charges": [{"minimum": 354.06, "maximum": 354.06, "gross_charge": 1686.0, "discounted_cash": 1264.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 354.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR TENDON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4020701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3005.1, "maximum": 3005.1, "gross_charge": 14310.0, "discounted_cash": 10732.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3005.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANDROLOGY INFERTILITY ASSMT", "code_information": [{"code": "255U", "type": "CPT"}], "standard_charges": [{"minimum": 31.6, "maximum": 31.6, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANDROSTANEDIOL GLUCURONIDE", "code_information": [{"code": "82154", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 147.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 147.06, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.29, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANDROSTENEDIONE", "code_information": [{"code": "82157", "type": "CPT"}, {"code": "7252157", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 149.29, "gross_charge": 355.0, "discounted_cash": 266.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD LVR TRNSPL", "code_information": [{"code": "796", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PNCRTECT", "code_information": [{"code": "794", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PRTL HPTC", "code_information": [{"code": "792", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT KNEE", "code_information": [{"code": "1404", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT PELVIS", "code_information": [{"code": "1140", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF FEMUR", "code_information": [{"code": "1232", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF PENIS", "code_information": [{"code": "932", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ARM-LEG VESSEL SURG", "code_information": [{"code": "1656", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CABG W/PUMP", "code_information": [{"code": "567", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST DRAINAGE", "code_information": [{"code": "524", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST SURGERY", "code_information": [{"code": "540", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CRAN SURG HEMOTOMA", "code_information": [{"code": "211", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FACIAL BONE SURGERY", "code_information": [{"code": "192", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL ARTERY SURG", "code_information": [{"code": "1272", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL EMBOLECTOMY", "code_information": [{"code": "1274", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FOREQUARTER AMPUT", "code_information": [{"code": "1636", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG <1 YR", "code_information": [{"code": "561", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG W/O PUMP", "code_information": [{"code": "560", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART/LUNG TRANSPLNT", "code_information": [{"code": "580", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP DISARTICULATION", "code_information": [{"code": "1212", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HRT SURG W/PMP AGE 1+", "code_information": [{"code": "562", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HYSTERECTOMY", "code_information": [{"code": "846", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY TRANSPLANT", "code_information": [{"code": "868", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY REPAIR", "code_information": [{"code": "1444", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY SURG", "code_information": [{"code": "1442", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LUNG CHEST WALL SURG", "code_information": [{"code": "546", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR LEG EMBOLECTOMY", "code_information": [{"code": "1502", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH MAJOR VEIN LIGATION", "code_information": [{"code": "882", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC ORGAN SURG", "code_information": [{"code": "848", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC TUMOR SURGERY", "code_information": [{"code": "1150", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "844", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "934", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "936", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PERINEAL SURGERY", "code_information": [{"code": "904", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PHARYNGEAL SURGERY", "code_information": [{"code": "176", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL FEMUR SURG", "code_information": [{"code": "1234", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL HUMERUS SURG", "code_information": [{"code": "1756", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF ADRENAL", "code_information": [{"code": "866", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF BLADDER", "code_information": [{"code": "864", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF NERVES", "code_information": [{"code": "632", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "908", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER JOINT AMPUT", "code_information": [{"code": "1634", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VESSEL SURG", "code_information": [{"code": "1652", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VESSEL SURG", "code_information": [{"code": "1654", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SITTING PROCEDURE", "code_information": [{"code": "604", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL DRAINAGE", "code_information": [{"code": "214", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL REPAIR/FRACT", "code_information": [{"code": "215", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF RIB", "code_information": [{"code": "474", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTHESA INIT 30 MIN", "code_information": [{"code": "6400003", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 2527.0, 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"payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTHESIOLOGY SS", "code_information": [{"code": "G0061", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGINA PECTORIS", "code_information": [{"code": "311", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23304.48, "maximum": 29366.79, "estimated_discounted_cash": 52443.07, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23304.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29366.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANGIO ADRENAL BILAT SEL", "code_information": [{"code": "75733", "type": "CPT"}, {"code": "4915734", "type": "CDM"}, {"code": "320", "type": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 492.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 492.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 492.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 492.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO ADRENAL UNILAT SEL", "code_information": [{"code": "75731", "type": "CPT"}, {"code": "4915732", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 2861.66, "gross_charge": 12085.0, "discounted_cash": 9063.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2537.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1371.07, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 453.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 453.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 453.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 453.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 453.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO EXIST CATH F/U STU", "code_information": [{"code": "75898", "type": "CPT"}, {"code": "4615898", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": 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"type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 2861.66, "gross_charge": 12146.0, "discounted_cash": 9109.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2550.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1401.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 479.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 479.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 479.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 479.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 479.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO EXTREMITY BILAT", "code_information": [{"code": "75716", "type": "CPT"}, {"code": "4905718", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 2861.66, "gross_charge": 11865.0, "discounted_cash": 8898.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2491.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1401.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, 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"plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 479.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 479.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 479.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 479.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO EXTREMITY UNILAT", "code_information": [{"code": "75710", "type": "CPT"}, {"code": "4615712", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 2861.66, "gross_charge": 11865.0, "discounted_cash": 8898.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2491.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1376.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 450.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 450.82, "methodology": "fee 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2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO EXTREMITY UNILAT", "code_information": [{"code": "75710", "type": "CPT"}, {"code": "4915712", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 2861.66, "gross_charge": 11865.0, "discounted_cash": 8898.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2491.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1376.1, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 450.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 450.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, 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{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1384.87, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 460.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 460.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 460.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 460.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 460.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO PELVIC SELECT/SUP", "code_information": [{"code": "75736", "type": 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 448.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 448.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 448.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 448.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO PELVIC SELECT/SUP", "code_information": [{"code": "75736", "type": "CPT"}, {"code": "4915737", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 4770.37, "gross_charge": 11275.0, "discounted_cash": 8456.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2367.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1371.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 448.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 448.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 448.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 448.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 448.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO PULM NON-SEL CATH", "code_information": [{"code": "75746", "type": "CPT"}, {"code": "4915747", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 2861.66, "gross_charge": 10294.0, "discounted_cash": 7720.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2161.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1359.78, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 440.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 463.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 463.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 463.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 463.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 463.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO PULMONARY UNI SLCT", "code_information": [{"code": "75741", "type": "CPT"}, {"code": "4915742", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 4959.78, "gross_charge": 23618.0, "discounted_cash": 17713.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4959.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1347.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 439.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 439.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 439.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 439.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 439.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO SELECT EA ADD VESL", "code_information": [{"code": "75774", "type": "CPT"}, {"code": "4613540", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1339.72, "gross_charge": 4817.0, "discounted_cash": 3612.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1011.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1339.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 383.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 383.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 383.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 383.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 383.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO SELECT EA ADD VESL", "code_information": [{"code": "75774", "type": "CPT"}, {"code": "4915775", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1344.63, "gross_charge": 6403.0, "discounted_cash": 4802.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1344.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1339.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 383.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 383.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 383.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 383.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 383.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO SPINAL SELECTIVE", "code_information": [{"code": "75705", "type": "CPT"}, {"code": "4915706", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 4770.37, "gross_charge": 16486.0, "discounted_cash": 12364.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3462.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1270.71, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 500.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 500.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 500.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 500.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 500.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO VISCERAL SEL/SUPSEL", "code_information": [{"code": "75726", "type": "CPT"}, {"code": "4615727", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 4770.37, "gross_charge": 18831.0, "discounted_cash": 14123.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3954.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1366.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 445.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 445.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 445.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 445.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 445.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO VISCERAL SEL/SUPSEL", "code_information": [{"code": "75726", "type": "CPT"}, {"code": "4915729", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 4770.37, "gross_charge": 19817.0, "discounted_cash": 14862.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4161.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1366.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 445.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 445.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 445.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 445.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 445.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO W/ US NON-CORONARY", "code_information": [{"code": "C7532", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANGIOSCOPY", "code_information": [{"code": "35400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 157.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 157.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 157.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 157.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 157.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANGIOTENSIN CONV ENZYME", "code_information": [{"code": "82164", "type": "CPT"}, {"code": "7252164", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.42, "gross_charge": 263.0, "discounted_cash": 197.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.42, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIOTENSIN CONV ENZYME/2", "code_information": [{"code": "82164", "type": "CPT"}, {"code": "7252165", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.42, "gross_charge": 84.0, "discounted_cash": 63.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.42, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIPLASTY ART EA ADDL", "code_information": [{"code": "4917247", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 681.0, "discounted_cash": 510.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIPLASTY ART INIT+S&I", "code_information": [{"code": "4617246", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 26068.0, "discounted_cash": 19551.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIPLASTY ART INIT+S&I", "code_information": [{"code": "4917246", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3254.0, "discounted_cash": 2440.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIPLASTY VEN EA ADDL", "code_information": [{"code": "4617249", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 32661.0, "discounted_cash": 24495.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIPLASTY VEN EA ADDL", "code_information": [{"code": "4917249", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2205.0, "discounted_cash": 1653.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIPLASTY VEN INIT+S&I", "code_information": [{"code": "4617248", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16732.0, "discounted_cash": 12549.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIPLASTY VEN INIT+S&I", "code_information": [{"code": "4917248", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2799.0, "discounted_cash": 2099.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANKLE 2 VIEWS", "code_information": [{"code": "73600", "type": "CPT"}, {"code": "4903600", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 258.3, "gross_charge": 1230.0, "discounted_cash": 922.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 258.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE 2 VIEWS", "code_information": [{"code": "73600", "type": "CPT"}, {"code": "5013600", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 258.3, "gross_charge": 1230.0, "discounted_cash": 922.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 258.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE 3 VIEWS MINIMUM", "code_information": [{"code": "73610", "type": "CPT"}, {"code": "4903610", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 370.44, "gross_charge": 1764.0, "discounted_cash": 1323.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 370.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 71.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE 3 VIEWS MINIMUM", "code_information": [{"code": "73610", "type": "CPT"}, {"code": "5013610", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 370.44, "gross_charge": 1764.0, "discounted_cash": 1323.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 370.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 71.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER 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HEALTH NETWORK WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROGRAPHY", "code_information": [{"code": "73615", "type": "CPT"}, {"code": "4903615", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 870.03, "gross_charge": 4143.0, "discounted_cash": 3107.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 870.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 264.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 121.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 121.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 121.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 121.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 121.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROGRAPHY", "code_information": [{"code": "73615", "type": "CPT"}, {"code": "4913615", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 870.03, "gross_charge": 4143.0, "discounted_cash": 3107.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 870.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 264.67, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 121.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 121.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 121.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 121.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 121.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29891", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29892", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29894", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29895", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29897", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 33800.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29898", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANL SP INF PMP W/MDREPRG&FIL", "code_information": [{"code": "62370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17509.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANN BREAST EXAM", "code_information": [{"code": "S0613", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANNUAL ALCOHOL SCREEN 15 MIN", "code_information": [{"code": "G0442", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANNUAL GYNECOLOGICAL EXAMINA", "code_information": [{"code": "S0610", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANNUAL GYNECOLOGICAL EXAMINA", "code_information": [{"code": "S0612", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANOGENITAL EXAM CHILD W IMAG", "code_information": [{"code": "99170", "type": "CPT"}], "standard_charges": [{"minimum": 225.99, "maximum": 258.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 232.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 225.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 258.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 258.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 258.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND BIOPSY", "code_information": [{"code": "46606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 140.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 140.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 140.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 140.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 140.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND DILATION", "code_information": [{"code": "46604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY CONTROL BLEEDING", "code_information": [{"code": "46614", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE FOR BODY", "code_information": [{"code": "46608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESION", "code_information": [{"code": "46610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESIONS", "code_information": [{"code": "46612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANS PARASYMP & SYMP W/TILT", "code_information": [{"code": "95924", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG I&R SPECLR MIC", "code_information": [{"code": "92286", "type": "CPT"}], "standard_charges": [{"minimum": 141.57, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 141.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 141.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 141.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 141.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 141.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG IR FLRSCN ANGRPH", "code_information": [{"code": "92287", "type": "CPT"}], "standard_charges": [{"minimum": 126.76, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 126.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 126.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 126.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 126.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 126.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG 8+", "code_information": [{"code": "22837", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG <7", "code_information": [{"code": "22836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTB TP TOTAL&RPR IA QUAL", "code_information": [{"code": "64U", "type": "CPT"}], "standard_charges": [{"minimum": 31.33, "maximum": 31.33, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEGRADE NEPHROSTOGRAM", "code_information": [{"code": "74425", "type": "CPT"}, {"code": "4904425", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 499.17, "gross_charge": 2377.0, "discounted_cash": 1782.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 499.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEGRADE NEPHROSTOGRAM", "code_information": [{"code": "74425", "type": "CPT"}, {"code": "4914425", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 499.17, "gross_charge": 2377.0, "discounted_cash": 1782.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 499.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59425", "type": "CPT"}], "standard_charges": [{"minimum": 12252.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59426", "type": "CPT"}], "standard_charges": [{"minimum": 12252.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM MANIPULATION", "code_information": [{"code": "59412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTERIOR COLPORRHAPHY", "code_information": [{"code": "57240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 14606.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTERIOR GAIT TRAINER", "code_information": [{"code": "E8002", "type": "HCPCS"}], "standard_charges": [{"minimum": 2439.08, "maximum": 2789.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2510.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2439.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2789.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2789.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2789.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTHRAX VACCINE SC OR IM", "code_information": [{"code": "90581", "type": "CPT"}], "standard_charges": [{"minimum": 106.92, "maximum": 118.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 106.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 118.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 118.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 118.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 118.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-GLOMERULAR BSMNT", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "7252322", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.84, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7198", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.17, "maximum": 2.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-PLA2R", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "7253607", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.84, "gross_charge": 215.0, "discounted_cash": 161.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-STREPTOLYSN O TITER", "code_information": [{"code": "86060", "type": "CPT"}, {"code": "4106060", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.23, "gross_charge": 256.0, "discounted_cash": 192.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 37.23, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.2, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL 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"standard_charge_dollar": 75.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORT/INF/IV/BPG COMP", "code_information": [{"code": "93978", "type": "CPT"}, {"code": "4630020", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 278.11, "maximum": 359.1, "gross_charge": 2263.0, "discounted_cash": 1697.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 278.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 323.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 314.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 278.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 278.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 278.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 278.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORT/INF/IV/BPG COMP", "code_information": [{"code": "93978", "type": "CPT"}, {"code": "5062020", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 278.11, "maximum": 359.1, "gross_charge": 750.0, "discounted_cash": 562.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 278.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 323.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 314.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 278.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 278.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 278.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 278.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORT/IVC/IV/BPG UNI/LTD", "code_information": [{"code": "93979", "type": "CPT"}, {"code": "4630030", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 153.23, "maximum": 192.96, "gross_charge": 1890.0, "discounted_cash": 1417.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 192.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 157.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 153.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 192.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 192.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 192.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 192.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [{"code": "268", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 287764.46, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 228360.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 287764.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [{"code": "269", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 176694.46, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 140218.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 176694.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 365.63, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 365.63, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 365.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 365.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 365.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33971", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 720.74, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 720.74, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 720.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 720.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 720.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81410", "type": "CPT"}], "standard_charges": [{"minimum": 504.0, "maximum": 504.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81411", "type": "CPT"}], "standard_charges": [{"minimum": 1350.19, "maximum": 1350.19, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1350.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1350.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC HEMIARCH GRAFT", "code_information": [{"code": "33866", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC SUSPENSION", "code_information": [{"code": "33800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1005.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1005.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1005.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1005.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1005.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APAP/BUTAL/CAF/ TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327036", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP/BUTAL/CAF/ TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327036", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP/COD 120/12 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327011", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP/COD 120/12 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327011", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP/COD 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327019", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP/COD 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327019", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APC GENE DUP/DELET VARIANTS", "code_information": [{"code": "81203", "type": "CPT"}], "standard_charges": [{"minimum": 200.0, "maximum": 200.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 200.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE FULL SEQUENCE", "code_information": [{"code": "81201", "type": "CPT"}], "standard_charges": [{"minimum": 780.0, "maximum": 780.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81202", "type": "CPT"}], "standard_charges": [{"minimum": 280.0, "maximum": 280.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC MRNA SEQ ALYS", "code_information": [{"code": "157U", "type": "CPT"}], "standard_charges": [{"minimum": 282.88, "maximum": 282.88, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHAKIA PROSTH SERVICE TEMP", "code_information": [{"code": "92358", "type": "CPT"}], "standard_charges": [{"minimum": 29.12, "maximum": 29.12, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS IMMUNOADS SLCTV", "code_information": [{"code": "36516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLASMA", "code_information": [{"code": "36514", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLATELETS", "code_information": [{"code": "36513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS RBC", "code_information": [{"code": "36512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS WBC", "code_information": [{"code": "36511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APIXABAN 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300772", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APIXABAN 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300772", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APIXABAN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300771", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APIXABAN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300771", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APLIGRAF PER SQ CM", "code_information": [{"code": "Q4101", "type": "HCPCS"}, {"code": "8240451", "type": "CDM"}], "standard_charges": [{"minimum": 125.37, "maximum": 125.37, "gross_charge": 597.0, "discounted_cash": 447.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 125.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOL1 RISK VARIANTS", "code_information": [{"code": "355U", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOLIPOPROTEIN/2", "code_information": [{"code": "82172", "type": "CPT"}, {"code": "7252173", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 79.02, "gross_charge": 121.0, "discounted_cash": 90.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOLIPOPROTEIN/3", "code_information": [{"code": "82172", "type": "CPT"}, {"code": "7252174", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 79.02, "gross_charge": 627.0, "discounted_cash": 470.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOLIPOPROTEIN/4", "code_information": [{"code": "82172", "type": "CPT"}, {"code": "7252176", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 79.02, "gross_charge": 121.0, "discounted_cash": 90.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOMORPHINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0364", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.62, "maximum": 39.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 35.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 39.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP LC SKNSB FNHG 1ST 100SC", "code_information": [{"code": "6900016", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB FNHG 1ST 100SC", "code_information": [{"code": "6900016", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB FNHG 1ST 25SC", "code_information": [{"code": "6900018", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB FNHG 1ST 25SC", "code_information": [{"code": "6900018", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB FNHG EA ADL 100SC", "code_information": [{"code": "6900015", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4930.0, "discounted_cash": 3697.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB FNHG EA ADL 100SC", "code_information": [{"code": "6900015", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 4930.0, "discounted_cash": 3697.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB FNHG EA ADL 25SC", "code_information": [{"code": "6900017", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5148.0, "discounted_cash": 3861.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB FNHG EA ADL 25SC", "code_information": [{"code": "6900017", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 5148.0, "discounted_cash": 3861.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB T/A/L 1ST 100SC", "code_information": [{"code": "6900021", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6213.0, "discounted_cash": 4659.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB T/A/L 1ST 100SC", "code_information": [{"code": "6900021", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 6213.0, "discounted_cash": 4659.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB T/A/L 1ST 25SC", "code_information": [{"code": "6900023", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB T/A/L 1ST 25SC", "code_information": [{"code": "6900023", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB T/A/L EA ADL 25SC", "code_information": [{"code": "6900022", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3777.0, "discounted_cash": 2832.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB T/A/L EA ADL 25SC", "code_information": [{"code": "6900022", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3777.0, "discounted_cash": 2832.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB TAL EA ADL 100SC", "code_information": [{"code": "6900019", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5375.0, "discounted_cash": 4031.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB TAL EA ADL 100SC", "code_information": [{"code": "6900019", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 5375.0, "discounted_cash": 4031.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APP MDLTY 1+CNTRST BTH EA 15", "code_information": [{"code": "97034", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 35.23, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 31.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 35.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 35.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 35.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+HUBBRD TNK EA 15", "code_information": [{"code": "97036", "type": "CPT"}], "standard_charges": [{"minimum": 21.56, "maximum": 83.45, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 75.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 72.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 83.45, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+IONTPHRSIS EA 15", "code_information": [{"code": "97033", "type": "CPT"}], "standard_charges": [{"minimum": 20.3, "maximum": 48.69, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 43.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 42.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 48.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 48.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 48.69, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+ULTRASOUND EA 15", "code_information": [{"code": "97035", "type": "CPT"}], "standard_charges": [{"minimum": 9.51, "maximum": 31.73, "estimated_discounted_cash": 349.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 28.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 27.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 31.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 31.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 31.73, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX 1ST", "code_information": [{"code": "20696", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX XCH", "code_information": [{"code": "20697", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APP SKNSUB F/N/H/G 1ST 100SC", "code_information": [{"code": "6900031", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6213.0, "discounted_cash": 4659.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB F/N/H/G 1ST 100SC", "code_information": [{"code": "6900031", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 6213.0, "discounted_cash": 4659.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB F/N/H/G 1ST 25SC", "code_information": [{"code": "6900029", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6213.0, "discounted_cash": 4659.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB F/N/H/G 1ST 25SC", "code_information": [{"code": "6900029", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 6213.0, "discounted_cash": 4659.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB F/N/H/G ADL 100SC", "code_information": [{"code": "6900024", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4764.0, "discounted_cash": 3573.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB F/N/H/G ADL 100SC", "code_information": [{"code": "6900024", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 4764.0, "discounted_cash": 3573.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB F/N/H/G EA ADL 25SC", "code_information": [{"code": "6900030", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3727.0, "discounted_cash": 2795.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB F/N/H/G EA ADL 25SC", "code_information": [{"code": "6900030", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3727.0, "discounted_cash": 2795.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB GRFT T/A/L 1ST100SC", "code_information": [{"code": "6900027", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12757.0, "discounted_cash": 9567.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB GRFT T/A/L 1ST100SC", "code_information": [{"code": "6900027", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 12757.0, "discounted_cash": 9567.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB GRFT T/A/L ADL100SC", "code_information": [{"code": "6900028", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4924.0, "discounted_cash": 3693.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB GRFT T/A/L ADL100SC", "code_information": [{"code": "6900028", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 4924.0, "discounted_cash": 3693.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB GRFT T/A/L ADL25SC", "code_information": [{"code": "6900026", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2870.0, "discounted_cash": 2152.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB GRFT T/A/L ADL25SC", "code_information": [{"code": "6900026", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2870.0, "discounted_cash": 2152.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB GRFT T/A/L<1ST 25SC", "code_information": [{"code": "6900025", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6213.0, "discounted_cash": 4659.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB GRFT T/A/L<1ST 25SC", "code_information": [{"code": "6900025", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 6213.0, "discounted_cash": 4659.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 590.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 590.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 590.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 590.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 590.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 787.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 787.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 787.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 787.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 787.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY ADD-ON", "code_information": [{"code": "44955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDICO-VESICOSTOMY", "code_information": [{"code": "50845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1287.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1287.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1287.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1287.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1287.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITH CC", "code_information": [{"code": "398", "type": "MS-DRG"}], "standard_charges": [{"minimum": 50254.55, "maximum": 63327.51, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50254.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63327.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITH MCC", "code_information": [{"code": "397", "type": "MS-DRG"}], "standard_charges": [{"minimum": 79515.47, "maximum": 100200.22, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 79515.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 100200.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "399", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38006.33, "maximum": 47893.1, "estimated_discounted_cash": 102833.28, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38006.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47893.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL HALO CRANIAL 6+PINS", "code_information": [{"code": "20664", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 731.1, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 731.1, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 731.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 731.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 731.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL MLTPLN UNI EXT FIXJ SYS", "code_information": [{"code": "20692", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL MODALITY 1+ESTIM EA 15", "code_information": [{"code": "97032", "type": "CPT"}], "standard_charges": [{"minimum": 13.5, "maximum": 33.93, "estimated_discounted_cash": 486.34, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPL MULTLAY COMPRS ARM/HAND", "code_information": [{"code": "29584", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL SHORT ARM SPLINT ST", "code_information": [{"code": "29125", "type": "CPT"}, {"code": "6059125", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 359.0, "discounted_cash": 269.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 75.39, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 341.05, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 341.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 132.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 269.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 269.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL UNIPLN UNI EXT FIXJ SYS", "code_information": [{"code": "20690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 11273.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLIANCE REMOVAL", "code_information": [{"code": "D7997", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO CRANIAL", "code_information": [{"code": "20661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 461.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 461.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 461.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 461.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 461.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO FEMORAL", "code_information": [{"code": "20663", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO PELVIC", "code_information": [{"code": "20662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION LONG LEG SPLINT", "code_information": [{"code": "29505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION LOWER LEG SPLINT", "code_information": [{"code": "29515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2856.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 33.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 33.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 33.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 33.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 33.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FIGURE EIGHT", "code_information": [{"code": "29049", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 44.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 44.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FINGER SPLINT", "code_information": [{"code": "29130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2292.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FINGER SPLINT", "code_information": [{"code": "29131", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FOREARM CAST", "code_information": [{"code": "29075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP CAST", "code_information": [{"code": "29305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP CASTS", "code_information": [{"code": "29325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LEG CAST", "code_information": [{"code": "29450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG ARM CAST", "code_information": [{"code": "29065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 61.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 61.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 61.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 61.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 59.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 59.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 59.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 59.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 59.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF PASTE BOOT", "code_information": [{"code": "29580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SHOULDER CAST", "code_information": [{"code": "29055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SHOULDER CAST", "code_information": [{"code": "29058", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATON ON-BODY INJECTOR", "code_information": [{"code": "96377", "type": "CPT"}], "standard_charges": [{"minimum": 4200.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY FINGER CAST", "code_information": [{"code": "29086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY FOREARM SPLINT", "code_information": [{"code": "29126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY HAND/WRIST CAST", "code_information": [{"code": "29085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT COMPL", "code_information": [{"code": "77763", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1220.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 687.42, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 718.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1099.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1220.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1220.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1220.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1220.92, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 718.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 718.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 718.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 718.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT INTERM", "code_information": [{"code": "77762", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 900.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 544.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 511.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 810.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 511.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 511.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 511.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 511.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT SIMPLE", "code_information": [{"code": "77761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 900.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 411.43, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 369.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 810.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 369.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 369.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 369.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 369.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY LONG ARM SPLINT", "code_information": [{"code": "29105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2859.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 42.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 42.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 42.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 42.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 42.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY LONG LEG CAST BRACE", "code_information": [{"code": "29358", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY ML COMPRS ARM/HAND", "code_information": [{"code": "5702959", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2311.0, "discounted_cash": 1733.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY ML COMPRS ARM/HAND", "code_information": [{"code": "6909892", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2311.0, "discounted_cash": 1733.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY ML COMPRS ARM/HAND", "code_information": [{"code": "6909892", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2311.0, "discounted_cash": 1733.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY ML COMPRS LWR LEG", "code_information": [{"code": "5702958", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 1551.0, "discounted_cash": 1163.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY ML COMPRS LWR LEG", "code_information": [{"code": "6900091", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1024.0, "discounted_cash": 768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY ML COMPRS LWR LEG", "code_information": [{"code": "6900091", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1024.0, "discounted_cash": 768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY MULTLAY COMPRS LWR LEG", "code_information": [{"code": "29581", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1456.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_percentage": 75.0, "possible_amount": 275.47, "count": "1 through 10", "median_amount": 275.47, "methodology": "percent of total billed charges", "10th_percentile": 275.47, "90th_percentile": 275.47}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY R&L PULM ART BANDS", "code_information": [{"code": "33620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY REM FIXATION DEVICE", "code_information": [{"code": "20660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY RIGID LEG CAST", "code_information": [{"code": "6900090", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1625.0, "discounted_cash": 1218.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY RIGID LEG CAST", "code_information": [{"code": "6900090", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1625.0, "discounted_cash": 1218.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY RIGID LEG CAST", "code_information": [{"code": "29445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1512.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "6900130", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1748.0, "discounted_cash": 1311.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "6900130", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1748.0, "discounted_cash": 1311.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1650.11, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 44.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 44.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1163.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 44.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 44.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 56.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 56.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 56.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 56.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 56.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SRS HEADFRAME ADD-ON", "code_information": [{"code": "61800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57137.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SURF LDR RADIONUCLIDE", "code_information": [{"code": "77789", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 202.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 97.84, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 106.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 182.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 202.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 202.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 202.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 202.68, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 106.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 106.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 106.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 106.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APROTONIN, 10,000 KIU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0365", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.39, "maximum": 2.65, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQAPRN-4 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86053", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQMBF PET REST & RX STRESS", "code_information": [{"code": "78434", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQMBF SPECT XERS/STRS & REST", "code_information": [{"code": "742T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUAPORIN-4 AB ELISA", "code_information": [{"code": "86051", "type": "CPT"}, {"code": "7250243", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUAPORINE 4 AB", "code_information": [{"code": "86052", "type": "CPT"}, {"code": "7253012", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "gross_charge": 2144.0, "discounted_cash": 1608.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/GRAFT", "code_information": [{"code": "66180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/O GRAFT", "code_information": [{"code": "66179", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AR FULL SEQUENCE ANALYSIS", "code_information": [{"code": "230U", "type": "CPT"}], "standard_charges": [{"minimum": 301.35, "maximum": 301.35, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR GENE CHARAC ALLELES", "code_information": [{"code": "81204", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR GENE FULL GENE SEQUENCE", "code_information": [{"code": "81173", "type": "CPT"}], "standard_charges": [{"minimum": 301.35, "maximum": 301.35, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR GENE KNOWN FAMIL VARIANT", "code_information": [{"code": "81174", "type": "CPT"}], "standard_charges": [{"minimum": 185.2, "maximum": 185.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARBUTAMINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0395", "type": "HCPCS"}], "standard_charges": [{"minimum": 144.0, "maximum": 160.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARCHITECT ECM PX FX 1 SQ CM", "code_information": [{"code": "Q4147", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARCHIV TISSUE EXAM MOLEC", "code_information": [{"code": "88363", "type": "CPT"}, {"code": "7270162", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 80.99, "gross_charge": 339.0, "discounted_cash": 254.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 80.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARFORMOTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7605", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.64, "maximum": 0.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROB N/ESRD1MG PMXIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0883", "type": "HCPCS"}, {"code": "5318346", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.72, "maximum": 0.8, "gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROB N/ESRD1MG PMXIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0883", "type": "HCPCS"}, {"code": "5318346", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.72, "maximum": 0.8, "gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0891", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.06, "maximum": 4.51, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD (AUROMED)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0898", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.46, "maximum": 1.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD 1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0883", "type": "HCPCS"}, {"code": "5318344", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.72, "maximum": 0.8, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD 1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0883", "type": "HCPCS"}, {"code": "5318344", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.72, "maximum": 0.8, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300784", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300784", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300780", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300780", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 2.5MG/2.5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314318", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 2.5MG/2.5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314318", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300777", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300777", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 5MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314277", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 5MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314277", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE LAUROXIL 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1944", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.02, "maximum": 3.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARSENIC TRIOXIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9017", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.34, "maximum": 8.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARSENIC/3", "code_information": [{"code": "82175", "type": "CPT"}, {"code": "7252175", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 96.76, "gross_charge": 417.0, "discounted_cash": 312.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 96.76, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AOR-CELIAC-MSN-RENAL", "code_information": [{"code": "35631", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1935.95, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1935.95, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1935.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1935.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1935.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AORSUBCL/CAROT/INNOM", "code_information": [{"code": "35626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1626.79, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1626.79, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1626.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1626.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1626.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBI-ILIAC", "code_information": [{"code": "35638", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1774.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1774.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1774.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1774.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1774.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBIFEMORAL", "code_information": [{"code": "35646", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1796.56, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1796.56, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1796.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1796.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1796.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOFEMORAL", "code_information": [{"code": "35647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1624.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1624.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1624.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1624.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1624.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOILIAC", "code_information": [{"code": "35637", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1747.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1747.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1747.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1747.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1747.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILL-FEM-FEMORAL", "code_information": [{"code": "35654", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1437.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1437.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1437.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1437.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1437.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-AXILLARY", "code_information": [{"code": "35650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1119.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1119.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1119.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1119.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1119.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-FEMORAL", "code_information": [{"code": "35621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1158.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1158.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1158.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1158.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1158.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-POP-TIBIAL", "code_information": [{"code": "35623", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1420.15, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1420.15, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1420.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1420.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1420.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-SUBCLAVIAN", "code_information": [{"code": "35606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1219.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1219.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1219.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1219.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1219.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-VERTEBRAL", "code_information": [{"code": "35642", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1054.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1054.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1054.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1054.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1054.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP COMMON IPSI CAROTID", "code_information": [{"code": "35601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1471.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1471.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1471.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1471.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1471.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35566", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1703.71, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1703.71, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1703.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1703.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1703.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35666", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1339.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1339.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1339.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1339.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1339.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-FEMORAL", "code_information": [{"code": "35661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1139.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1139.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1139.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1139.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1139.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-POPLITEAL", "code_information": [{"code": "35656", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1135.44, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1135.44, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1135.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1135.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1135.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AOR/CAROT/INNOM", "code_information": [{"code": "35526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1794.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1794.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1794.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1794.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1794.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORCEL/AORMESEN", "code_information": [{"code": "35531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2083.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2083.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2083.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2083.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2083.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTBIFEMORAL", "code_information": [{"code": "35540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2564.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2564.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2564.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2564.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2564.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOBI-ILIAC", "code_information": [{"code": "35538", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2455.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2455.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2455.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2455.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2455.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOFEMORAL", "code_information": [{"code": "35539", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2302.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2302.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2302.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2302.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2302.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOILIAC", "code_information": [{"code": "35537", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2199.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2199.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2199.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2199.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2199.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTORENAL", "code_information": [{"code": "35560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1850.79, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1850.79, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1850.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1850.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1850.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-BRACHIAL", "code_information": [{"code": "35522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1245.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1245.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1245.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1245.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1245.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-FEMORAL", "code_information": [{"code": "35521", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1322.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1322.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1322.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1322.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1322.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL/FEM/FEM", "code_information": [{"code": "35533", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1620.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1620.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1620.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1620.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1620.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILLARY-AXILRY", "code_information": [{"code": "35518", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1236.56, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1236.56, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1236.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1236.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1236.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRACHIAL-BRCHL", "code_information": [{"code": "35525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1178.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1178.59, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1178.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1178.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1178.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRCHL-ULNR-RDL", "code_information": [{"code": "35523", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1307.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1307.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1307.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1307.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1307.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-BRCHIAL", "code_information": [{"code": "35510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.37, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.37, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-VERTBRL", "code_information": [{"code": "35508", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1390.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1390.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1390.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1390.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1390.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CONTRAL CAROTID", "code_information": [{"code": "35509", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1523.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1523.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1523.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1523.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1523.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-FEMORAL", "code_information": [{"code": "35558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1276.12, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1276.12, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1276.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1276.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1276.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1424.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1424.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1424.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1424.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1424.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT HEPATORENAL", "code_information": [{"code": "35535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOFEMORAL", "code_information": [{"code": "35565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1373.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1373.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1373.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1373.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1373.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOILIAC", "code_information": [{"code": "35563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1439.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1439.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1439.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1439.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1439.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT IPSILAT CAROTID", "code_information": [{"code": "35501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1562.4, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1562.4, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1562.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1562.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1562.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SPLENORENAL", "code_information": [{"code": "35536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1802.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1802.59, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1802.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1802.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1802.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-AXILARY", "code_information": [{"code": "35516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1221.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1221.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1221.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1221.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1221.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-BRCHIAL", "code_information": [{"code": "35512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1278.1, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1278.1, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1278.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1278.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1278.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-CAROTID", "code_information": [{"code": "35506", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1356.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1356.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1356.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1356.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1356.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-SUBCLAV", "code_information": [{"code": "35511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1234.17, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1234.17, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1234.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1234.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1234.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-VERTBRL", "code_information": [{"code": "35515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1393.71, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1393.71, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1393.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1393.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1393.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-CELIAC", "code_information": [{"code": "35632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-MESENTERIC", "code_information": [{"code": "35633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOFEMORAL", "code_information": [{"code": "35665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1235.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1235.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1235.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1235.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1235.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOILIAC", "code_information": [{"code": "35663", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1317.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1317.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1317.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1317.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1317.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIORENAL", "code_information": [{"code": "35634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1405.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1405.59, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1405.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1405.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1405.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35671", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1179.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1179.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1179.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1179.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1179.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP SPENORENAL", "code_information": [{"code": "35636", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1709.27, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1709.27, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1709.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1709.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1709.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-AXILLARY", "code_information": [{"code": "35616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1158.95, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1158.95, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1158.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1158.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1158.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-SUBCLAVIAN", "code_information": [{"code": "35612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 959.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 959.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 959.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 959.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 959.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-VERTEBRL", "code_information": [{"code": "35645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1075.33, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1075.33, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1075.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1075.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1075.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP TIBIAL-TIB/PERONEAL", "code_information": [{"code": "35570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART PRESSURE WAVEFORM ANALYS", "code_information": [{"code": "93050", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ CAROTID SUBCLAV", "code_information": [{"code": "35695", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1115.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1115.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1115.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1115.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1115.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAV CAROTID", "code_information": [{"code": "35694", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1079.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1079.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1079.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1079.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1079.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAVIAN", "code_information": [{"code": "35693", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 919.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 919.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 919.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 919.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 919.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ VERTBRL CAROTID", "code_information": [{"code": "35691", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1033.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1033.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1033.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1033.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1033.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTEMETHER-LUMEFANT 20-120 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300860", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTEMETHER-LUMEFANT 20-120 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300860", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOG CAR NKHD SEL", "code_information": [{"code": "4616226", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 41200.0, "discounted_cash": 30900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOG CAR NKHD SEL", "code_information": [{"code": "4916226", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16486.0, "discounted_cash": 12364.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOG EXT CAR SEL", "code_information": [{"code": "4616232", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19508.0, "discounted_cash": 14631.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOG EXT CAR SEL", "code_information": [{"code": "4916232", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21013.0, "discounted_cash": 15759.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOG SUBC/INOM", "code_information": [{"code": "4916228", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8405.0, "discounted_cash": 6303.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOG VERT SEL", "code_information": [{"code": "4916230", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 28153.0, "discounted_cash": 21114.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOGR CAR HD SEL", "code_information": [{"code": "4916224", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16486.0, "discounted_cash": 12364.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOGR CAR NK SEL", "code_information": [{"code": "4616222", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 26399.0, "discounted_cash": 19799.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOGR CAR NK SEL", "code_information": [{"code": "4916222", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9555.0, "discounted_cash": 7166.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERY EXPOS/GRAFT ARTERY", "code_information": [{"code": "33987", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY TO VEIN SHUNT", "code_information": [{"code": "36835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY TRANSPOSE/ENDOVAS TAA", "code_information": [{"code": "33889", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 819.71, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 819.71, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 819.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 819.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 819.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN AUTOGRAFT", "code_information": [{"code": "36825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN NONAUTOGRAFT", "code_information": [{"code": "36830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHR SI JT OPN B1GRF INSTRM", "code_information": [{"code": "27280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1011.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1011.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1011.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1011.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1011.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 2-3 VRT SGM", "code_information": [{"code": "22808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1779.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1779.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1779.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1779.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1779.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 4-7 VRT SGM", "code_information": [{"code": "22810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1988.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1988.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1988.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1988.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1988.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 8+ VRT SGM", "code_information": [{"code": "22812", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2181.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2181.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2181.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2181.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2181.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD CERVICAL EA", "code_information": [{"code": "22552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC CRV", "code_information": [{"code": "22554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1261.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1261.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1261.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1261.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1261.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC EA", "code_information": [{"code": "22585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1259.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1259.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1259.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1259.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1259.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC LUM", "code_information": [{"code": "22558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1460.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1460.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1460.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1460.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1460.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC THC", "code_information": [{"code": "22556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBDY CERVICAL", "code_information": [{"code": "22551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 39311.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT TORAL/XORAL C1-C2", "code_information": [{"code": "22548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1793.15, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1793.15, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1793.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1793.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1793.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD CMBN 1NTRSPC EA ADDL", "code_information": [{"code": "22634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD CMBN 1NTRSPC LUMBAR", "code_information": [{"code": "22633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14727.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD GLENOHUMERAL JT W/GRF", "code_information": [{"code": "23802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD HIP JT SBTRCHC OSTEOT", "code_information": [{"code": "27286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1600.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1600.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1600.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1600.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1600.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ EA AD", "code_information": [{"code": "22534", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 364.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 364.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 364.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 364.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 364.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ LMBR", "code_information": [{"code": "22533", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1560.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1560.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1560.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1560.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1560.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ THRC", "code_information": [{"code": "22532", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1670.29, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1670.29, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1670.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1670.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1670.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PRE-SAC NTRBDY L5-S1", "code_information": [{"code": "22586", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 13+ VRT SGM", "code_information": [{"code": "22804", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2423.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2423.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2423.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2423.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2423.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 7-12 VRT SGM", "code_information": [{"code": "22802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2093.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2093.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2093.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2093.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2093.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM<6 VRT SGM", "code_information": [{"code": "22800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1322.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1322.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1322.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1322.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1322.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC CRV", "code_information": [{"code": "22600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1214.58, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1214.58, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1214.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1214.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1214.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC EA ADD", "code_information": [{"code": "22614", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 394.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 394.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 394.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 394.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 394.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC LM EA", "code_information": [{"code": "22632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 320.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 320.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 320.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 320.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 320.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC LUM", "code_information": [{"code": "22630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 39287.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1491.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1491.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1491.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1491.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1491.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC LUMBAR", "code_information": [{"code": "22612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 16748.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3883.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3883.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3883.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3883.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3883.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC THRC", "code_information": [{"code": "22610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1200.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1200.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1200.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1200.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1200.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ ATLAS-AXIS", "code_information": [{"code": "22595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1416.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1416.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1416.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1416.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1416.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ CRANIOCERVICAL", "code_information": [{"code": "22590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1487.74, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1487.74, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1487.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1487.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1487.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD SI JT PERQ/MIN NVAS", "code_information": [{"code": "27279", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17494.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD SI JT PRQ WO TFXJ DEV", "code_information": [{"code": "27278", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRO, LOOSE BODY + CHONDRO", "code_information": [{"code": "G0289", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRO/SHOUL SURG; W/SPACER", "code_information": [{"code": "C9781", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS GLENOHUMERAL JT", "code_information": [{"code": "23800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS HIP JOINT", "code_information": [{"code": "27284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1584.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1584.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1584.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1584.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1584.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS SYMPHYSIS PUBIS", "code_information": [{"code": "27282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 819.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 819.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 819.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 819.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 819.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROEREISIS, SUBTALAR", "code_information": [{"code": "S2117", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROFLEX PER SQ CM", "code_information": [{"code": "Q4125", "type": "HCPCS"}, {"code": "4020720", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1198.89, "maximum": 1198.89, "gross_charge": 5709.0, "discounted_cash": 4281.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1198.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROFLEX PER SQ CM", "code_information": [{"code": "Q4125", "type": "HCPCS"}, {"code": "4020720", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1198.89, "maximum": 1198.89, "gross_charge": 5709.0, "discounted_cash": 4281.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1198.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, SHOULDER, SURGI", "code_information": [{"code": "S2300", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBOW W/SYNOVECTOMY", "code_information": [{"code": "24102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW CAPSL EXC RLS", "code_information": [{"code": "24006", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW EXPL DRG/RMVL FB", "code_information": [{"code": "24000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW JT EXPL BX RMVL", "code_information": [{"code": "24101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW SYNOVIAL BX ONLY", "code_information": [{"code": "24100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTICULAR COMPONENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8131014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8439.69, "maximum": 8439.69, "gross_charge": 40189.0, "discounted_cash": 30141.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 8439.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL INSEMINATION", "code_information": [{"code": "58321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL INSEMINATION", "code_information": [{"code": "58322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTISS FIBRIN SEALANT", "code_information": [{"code": "C9250", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 209.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 188.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 209.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 209.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 209.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 209.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AS-AORT GRF F/AORTIC DSJ", "code_information": [{"code": "33858", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AS-AORT GRF F/DS OTH/THN DSJ", "code_information": [{"code": "33859", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASA/ANTIPLAT THER USED", "code_information": [{"code": "G8598", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33863", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3083.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3083.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3083.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3083.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3083.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33864", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3175.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3175.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3175.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3175.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3175.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASCORBIC ACID", "code_information": [{"code": "82180", "type": "CPT"}, {"code": "7252180", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.41, "gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 50.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.81, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASHKENAZI JEWISH ASSOC DIS", "code_information": [{"code": "81412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2448.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2241.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2448.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2448.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASP ABS/HEMAT/CYST", "code_information": [{"code": "4910160", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASP ABS/HEMAT/CYST", "code_information": [{"code": "5050160", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASP ABS/HEMAT/CYST", "code_information": [{"code": "5061160", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASP ABS/HEMAT/CYST", "code_information": [{"code": "6900132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 718.0, "discounted_cash": 538.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ASP ABS/HEMAT/CYST", "code_information": [{"code": "6900132", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 718.0, "discounted_cash": 538.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ASP/INJ GANGLION CYST", "code_information": [{"code": "4910612", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2651.0, "discounted_cash": 1988.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASP/INJ INTERM JT 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{"description": "ASP/INJ RENL CYST/PELVIS", "code_information": [{"code": "5067610", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3915.0, "discounted_cash": 2936.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPA GENE COMMON VARIANT", "code_information": [{"code": "81200", "type": "CPT"}, {"code": "7251200", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 47.25, "maximum": 47.25, "gross_charge": 1050.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPARAGINASE, NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9020", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.1, "maximum": 64.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 64.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 64.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 64.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 64.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS AB", "code_information": [{"code": "86606", "type": "CPT"}, {"code": "7256606", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.76, "gross_charge": 171.0, "discounted_cash": 128.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH 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"ASPIR/INJ MAJ JT WO/US", "code_information": [{"code": "5050610", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3659.0, "discounted_cash": 2744.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ MAJ JT WO/US", "code_information": [{"code": "5060610", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 872.0, "discounted_cash": 654.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ MAJOR JT W/US", "code_information": [{"code": "4910611", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2339.0, "discounted_cash": 1754.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ MAJOR JT W/US", "code_information": [{"code": "5060611", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3659.0, "discounted_cash": 2744.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ SM JNT WO/US", "code_information": [{"code": "4900600", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2044.0, "discounted_cash": 1533.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ SM JNT WO/US", "code_information": [{"code": "4910600", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2044.0, "discounted_cash": 1533.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ THYROID CYST", "code_information": [{"code": "4917400", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3811.0, "discounted_cash": 2858.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ THYROID CYST", "code_information": [{"code": "5067400", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3811.0, "discounted_cash": 2858.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ THYROID CYST", "code_information": [{"code": "60300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATE PLEURA W/ IMAGING", "code_information": [{"code": "32555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17320.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATE PLEURA W/O IMAGING", "code_information": [{"code": "32554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATE/INJ GANGLION CYST", "code_information": [{"code": "20612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATION ORBITAL CONTENTS", "code_information": [{"code": "67415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY ALKALINE PHOSPHATASE", "code_information": [{"code": "84078", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 37.23, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.2, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY BLOOD CATECHOLAMINES", "code_information": [{"code": "82383", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 127.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 127.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY CARBOXYHB QUAL", "code_information": [{"code": "82376", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY TOXIN OR ANTITOXIN", "code_information": [{"code": "87230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 100.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 100.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY URINE CATECHOLAMINES", "code_information": [{"code": "82382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 87.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 87.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSESS CYST CONTRAST INJECT", "code_information": [{"code": "49424", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSESS VOL MGMT NOT DOC", "code_information": [{"code": "G8958", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASSESSMENT FOR HEARING AID", "code_information": [{"code": "V5010", "type": "HCPCS"}], "standard_charges": [{"minimum": 94.28, "maximum": 107.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 97.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 94.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 107.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 107.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 107.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSESSMENT OF APHASIA", "code_information": [{"code": "96105", "type": "CPT"}], "standard_charges": [{"minimum": 65.97, "maximum": 239.09, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 215.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 209.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 239.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 239.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 239.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSIST OOCYTE FERTILIZATION", "code_information": [{"code": "89280", "type": "CPT"}], "standard_charges": [{"minimum": 656.15, "maximum": 656.15, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSIST OOCYTE FERTILIZATION", "code_information": [{"code": "89281", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSISTIVE TECHNOLOGY ASSESS", "code_information": [{"code": "97755", "type": "CPT"}], "standard_charges": [{"minimum": 27.32, "maximum": 85.87, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 77.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 75.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 85.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 85.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 85.87, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASST OOCYTE FERT CASE RATE", "code_information": [{"code": "S4022", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTHMA EDUCATION", "code_information": [{"code": "S9441", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTHMA KIT", "code_information": [{"code": "S8097", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASTIGMATISM CORRECT IOL", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "8120100", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2692.0, "discounted_cash": 2019.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "ASXL1 FULL GENE SEQUENCE", "code_information": [{"code": "81175", "type": "CPT"}], "standard_charges": [{"minimum": 676.5, "maximum": 676.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 676.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 676.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASXL1 GENE TARGET SEQ ALYS", "code_information": [{"code": "81176", "type": "CPT"}], "standard_charges": [{"minimum": 241.9, "maximum": 241.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 241.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 241.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASY THIOPURIN S-MTHYLTRNSFRS", "code_information": [{"code": "84433", "type": "CPT"}], "standard_charges": [{"minimum": 22.17, "maximum": 22.17, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATENOLOL 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301137", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ATENOLOL 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301137", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ATENOLOL 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301138", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ATENOLOL 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301138", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ATEZOLIZUMAB PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9022", "type": "HCPCS"}, {"code": "5318363", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 82.21, "maximum": 91.34, "gross_charge": 395.0, "discounted_cash": 296.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 82.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 91.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 91.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 91.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 91.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATEZOLIZUMAB PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9022", "type": "HCPCS"}, {"code": "5318363", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 82.21, "maximum": 91.34, "gross_charge": 395.0, "discounted_cash": 296.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 82.21, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7636", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.11, "maximum": 0.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTACH BLADDER/URETHRA", "code_information": [{"code": "51840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 677.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 677.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 677.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 677.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 677.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATTACH BLADDER/URETHRA", "code_information": [{"code": "51841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATTACH OCULAR IMPLANT", "code_information": [{"code": "65140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC AFTER CARE", "code_information": [{"code": "59622", "type": "CPT"}], "standard_charges": [{"minimum": 1160.54, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1160.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1160.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1160.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1160.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1160.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY", "code_information": [{"code": "59618", "type": "CPT"}], "standard_charges": [{"minimum": 2079.49, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2079.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2079.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2079.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2079.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2079.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY ONLY", "code_information": [{"code": "59620", "type": "CPT"}], "standard_charges": [{"minimum": 985.32, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 985.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 985.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 985.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 985.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 985.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTENDANT CARE SERVICE /15M", "code_information": [{"code": "S5125", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTENDANT CARE SERVICE /DIEM", "code_information": [{"code": "S5126", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATXN1 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81178", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN10 GENE DETC ABNOR ALLEL", "code_information": [{"code": "81183", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN2 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81179", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN3 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81180", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN7 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81181", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN8OS GEN DETC ABNOR ALLEL", "code_information": [{"code": "81182", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUD BRAINSTEM IMPLT PROGRAMG", "code_information": [{"code": "92640", "type": "CPT"}], "standard_charges": [{"minimum": 61.98, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIO-ONLY HHS", "code_information": [{"code": "G0321", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDIOLOGY SS", "code_information": [{"code": "G0062", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR & BONE", "code_information": [{"code": "92553", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY FOR HEARING AID", "code_information": [{"code": "S0618", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY PURE TONE AIR ONLY", "code_information": [{"code": "92552", "type": "CPT"}, {"code": "6702552", "type": "CDM"}, {"code": "471", "type": "RC"}], "standard_charges": [{"minimum": 145.03, "maximum": 165.85, "gross_charge": 564.0, "discounted_cash": 423.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDITORY FUNCTION + 15 MIN", "code_information": [{"code": "92621", "type": "CPT"}], "standard_charges": [{"minimum": 17.45, "maximum": 17.45, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDITORY FUNCTION 60 MIN", "code_information": [{"code": "92620", "type": "CPT"}], "standard_charges": [{"minimum": 72.68, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 72.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 72.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 72.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 72.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 72.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION CHEEK BONE", "code_information": [{"code": "21270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21127", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION OF FACIAL BONES", "code_information": [{"code": "21208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AURICULAR ELECTROSTIMULATION", "code_information": [{"code": "S8930", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUROTHIOGLUCOSE INJECITON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2910", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.05, "maximum": 24.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 22.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29866", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTO ALYS XST CT STD VRT FX", "code_information": [{"code": "691T", "type": "CPT"}], "standard_charges": [{"minimum": 8.47, "maximum": 8.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO DIFF WBC COUNT", "code_information": [{"code": "85004", "type": "CPT"}, {"code": "4105004", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.0, "gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ CPTR ALYS", "code_information": [{"code": "625T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ DATA PREP", "code_information": [{"code": "624T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ I&R", "code_information": [{"code": "626T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO QUANTIFICATION C PLAQUE", "code_information": [{"code": "623T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOCHONDROCYTE IMPLANT KNEE", "code_information": [{"code": "27412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1623.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1623.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1623.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1623.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1623.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOIMMUNE RA ALYS 12 BMRK", "code_information": [{"code": "81490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2198.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2198.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOL CELL IMPLT ADPS HRVG", "code_information": [{"code": "565T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOL CELL IMPLT ADPS NJX", "code_information": [{"code": "566T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOLOG PRP DIAB WOUND ULCER", "code_information": [{"code": "G0465", "type": "HCPCS"}, {"code": "6900465", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2344.51, "maximum": 2681.12, "gross_charge": 1495.0, "discounted_cash": 1121.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2413.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2344.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2681.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2681.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2681.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOLOG PRP DIAB WOUND ULCER", "code_information": [{"code": "G0465", "type": "HCPCS"}, {"code": "6900465", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 2344.51, "maximum": 2681.12, "gross_charge": 1495.0, "discounted_cash": 1121.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2413.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2344.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2681.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2681.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2681.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOLOG PRP NOT DIAB ULCER", "code_information": [{"code": "G0460", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BLOOD", "code_information": [{"code": "86890", "type": "CPT"}, {"code": "4500073", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "gross_charge": 995.0, "discounted_cash": 746.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC", "code_information": [{"code": "16", "type": "MS-DRG"}], "standard_charges": [{"minimum": 196877.9, "maximum": 248092.72, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 196877.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 248092.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC", "code_information": [{"code": "17", "type": "MS-DRG"}], "standard_charges": [{"minimum": 180363.22, "maximum": 227282.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 180363.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 227282.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOMATIC BP MONITOR, DIAL", "code_information": [{"code": "A4670", "type": "HCPCS"}], "standard_charges": [{"minimum": 82.81, "maximum": 94.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 85.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 82.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 94.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 94.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 94.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV ADRENRG INERVJ", "code_information": [{"code": "95922", "type": "CPT"}], "standard_charges": [{"minimum": 89.65, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV PARASYM INERVJ", "code_information": [{"code": "95921", "type": "CPT"}], "standard_charges": [{"minimum": 75.79, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 75.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 75.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 75.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 75.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 75.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV SYST FUNJ TEST", "code_information": [{"code": "95923", "type": "CPT"}], "standard_charges": [{"minimum": 131.33, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 131.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 131.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 131.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 131.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 131.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88020", "type": "CPT"}], "standard_charges": [{"minimum": 362.54, "maximum": 362.54, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 362.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 362.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88025", "type": "CPT"}], "standard_charges": [{"minimum": 350.68, "maximum": 350.68, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 350.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 350.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88027", "type": "CPT"}], "standard_charges": [{"minimum": 374.05, "maximum": 374.05, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 374.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 374.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88028", "type": "CPT"}], "standard_charges": [{"minimum": 210.41, "maximum": 210.41, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 210.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 210.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88029", "type": "CPT"}], "standard_charges": [{"minimum": 210.41, "maximum": 210.41, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 210.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 210.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88000", "type": "CPT"}], "standard_charges": [{"minimum": 210.41, "maximum": 210.41, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 210.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 210.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88005", "type": "CPT"}], "standard_charges": [{"minimum": 245.65, "maximum": 245.65, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 245.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 245.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88007", "type": "CPT"}], "standard_charges": [{"minimum": 257.16, "maximum": 257.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 257.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 257.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88012", "type": "CPT"}], "standard_charges": [{"minimum": 210.41, "maximum": 210.41, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 210.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 210.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88014", "type": "CPT"}], "standard_charges": [{"minimum": 192.96, "maximum": 192.96, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 192.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 192.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88016", "type": "CPT"}], "standard_charges": [{"minimum": 269.03, "maximum": 269.03, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 269.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 269.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOTRANSPLANT PARATHYROID", "code_information": [{"code": "60512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION", "code_information": [{"code": "36833", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION OPEN", "code_information": [{"code": "36832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM BASILIC", "code_information": [{"code": "36819", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM CEPHALIC", "code_information": [{"code": "36818", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FUSION DIRECT ANY SITE", "code_information": [{"code": "36821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 33800.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FUSION/FOREARM VEIN", "code_information": [{"code": "36820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV TUNNELER/SCNLN SHEATH", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8201079", "type": "CDM"}], "standard_charges": [{"minimum": 351.96, "maximum": 351.96, "gross_charge": 1676.0, "discounted_cash": 1257.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 351.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AXICABTAGENE CILOLEUCEL CAR+", "code_information": [{"code": "Q2041", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AZATHIOPRINE PARENTERAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7501", "type": "HCPCS"}], "standard_charges": [{"minimum": 256.5, "maximum": 285.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 256.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYC 200/5 30ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314304", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 71.25, "setting": "both", "billing_class": "facility"}]}, {"description": "AZITHROMYC 200/5 30ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314304", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 71.25, "setting": "both", "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 1GM PWLQ", "code_information": [{"code": "Q0144", "type": "HCPCS"}, {"code": "5314303", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 22.7, "maximum": 36.54, "gross_charge": 174.0, "discounted_cash": 130.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW 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"standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLISTOCARDIOGRAM", "code_information": [{"code": "S3902", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BALLOON DILATE URTRL STRIX", "code_information": [{"code": "50706", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BALO ANGIOP CTR DIALYSIS SEG", "code_information": [{"code": "36907", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BALOON DILATE URETER", "code_information": [{"code": "4910706", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8281.0, "discounted_cash": 6210.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BARBITURATE/4", "code_information": [{"code": "80345", "type": "CPT"}, {"code": "7252210", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 850.0, "discounted_cash": 637.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARIUM ENEMA THERAPEUTIC", "code_information": [{"code": "74283", "type": "CPT"}, {"code": "4904283", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1039.08, "gross_charge": 4948.0, "discounted_cash": 3711.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1039.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 291.02, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 230.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 230.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 230.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 230.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 230.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARIUM PWD SUSP 40% 148G", "code_information": [{"code": "5355103", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 99.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BARIUM PWD SUSP 96% 176G", "code_information": [{"code": "5355104", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BARIUM PWD SUSP 98% 340G", "code_information": [{"code": "5355140", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BARIUM SULF 700MG TB", "code_information": [{"code": "5355145", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BARIUM SUSP 2.1%450ML LQ", "code_information": [{"code": "5355176", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BARIUM SUSP 40% 250ML LQ", "code_information": [{"code": "5355264", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BARRIER ADH SEPRA GEL", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "8172007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 991.83, "maximum": 991.83, "gross_charge": 4723.0, "discounted_cash": 3542.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 991.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARRIER ADHESION 2", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "8240515", "type": "CDM"}], "standard_charges": [{"minimum": 1247.4, "maximum": 1247.4, "gross_charge": 5940.0, "discounted_cash": 4455.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1247.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA AB", "code_information": [{"code": "86611", "type": "CPT"}, {"code": "7256608", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.9, "gross_charge": 180.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA AB/3", "code_information": [{"code": "86611", "type": "CPT"}, {"code": "7256611", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.9, "gross_charge": 59.0, "discounted_cash": 44.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA AB/4", "code_information": [{"code": "86611", "type": "CPT"}, {"code": "7256612", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.9, "gross_charge": 134.0, "discounted_cash": 100.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA AB/5", "code_information": [{"code": "86611", "type": "CPT"}, {"code": "7256613", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.9, "gross_charge": 134.0, "discounted_cash": 100.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA AB/6", "code_information": [{"code": "86611", "type": "CPT"}, {"code": "7256614", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.9, "gross_charge": 134.0, "discounted_cash": 100.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA AMP PRB", "code_information": [{"code": "87471", "type": "CPT"}, {"code": "7257471", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "gross_charge": 393.0, "discounted_cash": 294.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA DNA QUANT", "code_information": [{"code": "87472", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 218.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 218.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", 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[{"code": "97152", "type": "CPT"}], "standard_charges": [{"minimum": 45.46, "maximum": 51.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 45.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BICALUTAMIDE 50MG TB", "drug_information": {"unit": 1.0, 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NETWORK", "standard_charge_dollar": 11565.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20188.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29225.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21243.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30751.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14678.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12169.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12851.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 22432.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32472.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15499.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32472.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 22432.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12851.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15499.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 22432.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12851.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15499.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32472.7, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7343.47, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 24475.19, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13945.94, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9168.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 183374.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 231076.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [{"code": "462", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6447.22, "maximum": 111291.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21436.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7909.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 48114.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11550.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50627.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8323.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12153.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22556.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23818.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 53461.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8788.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12834.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 53461.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8788.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12834.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23818.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8788.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12834.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 53461.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23818.44, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9473.85, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 44923.14, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 18515.88, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6447.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 88317.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 111291.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS CHOLYLGLYCINE", "code_information": [{"code": "82240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 135.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 135.52, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.13, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS TOTAL/2", "code_information": [{"code": "82239", "type": "CPT"}, {"code": "7252241", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 87.38, "gross_charge": 384.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 87.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE DUCT ENDOSCOPY ADD-ON", "code_information": [{"code": "47550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 156.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 156.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 156.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 156.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 156.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILE DUCT REVISION", "code_information": [{"code": "47701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1596.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1596.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1596.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1596.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1596.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY DIL W/WO STENT", "code_information": [{"code": "74363", "type": "CPT"}, {"code": "4914363", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1583.4, "gross_charge": 7540.0, "discounted_cash": 5655.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1583.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDO DIL W/STENT", "code_information": [{"code": "4918210", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16720.0, "discounted_cash": 12540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BILIARY ENDO PERQ DX W/SPECI", "code_information": [{"code": "47552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1282.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [{"code": "409", "type": "MS-DRG"}], "standard_charges": [{"minimum": 72290.71, "maximum": 91096.05, "estimated_discounted_cash": 95992.08, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 72290.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 91096.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "408", "type": "MS-DRG"}], "standard_charges": [{"minimum": 118385.05, "maximum": 149181.14, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 118385.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149181.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "410", "type": "MS-DRG"}], "standard_charges": [{"minimum": 52714.82, "maximum": 66427.78, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 52714.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 66427.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN DIRECT", "code_information": [{"code": "82248", "type": "CPT"}, {"code": "4102253", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.62, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "7252247", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.62, "gross_charge": 130.0, "discounted_cash": 97.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL/2", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "4102250", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.62, "gross_charge": 241.0, "discounted_cash": 180.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL/2", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "7252250", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.62, "gross_charge": 126.0, "discounted_cash": 94.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL/3", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "4102252", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.62, "gross_charge": 261.0, "discounted_cash": 195.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTL TRNSCTNS", "code_information": [{"code": "88720", "type": "CPT"}, {"code": "4108400", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.75, "gross_charge": 97.0, "discounted_cash": 72.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILOBECTOMY", "code_information": [{"code": "32482", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1594.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1594.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1594.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1594.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1594.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIO MTRLS TO AID SOFT/OS REG", "code_information": [{"code": "D4265", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.63, "maximum": 208.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 187.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 182.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 208.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 208.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 208.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOAVAILABLE TESTOSTERONE/2", "code_information": [{"code": "84410", "type": "CPT"}, {"code": "7254411", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 270.1, "gross_charge": 812.0, "discounted_cash": 609.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 270.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 51.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 51.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOAVAILABLE TESTOSTERONE/4", "code_information": [{"code": "84410", "type": "CPT"}, {"code": "7254413", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 270.1, "gross_charge": 294.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 270.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 51.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 51.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIODFENCE 1CM", "code_information": [{"code": "Q4140", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIODFENCE DRYFLEX, 1CM", "code_information": [{"code": "Q4138", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOFEEDBACK TRAIN ANY METH", "code_information": [{"code": "90901", "type": "CPT"}], "standard_charges": [{"minimum": 35.67, "maximum": 40.79, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 35.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 40.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40.79, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOFIRE 22 TRGT SARSCOV2", "code_information": [{"code": "202U", "type": "CPT"}, {"code": "7250513", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 416.78, "maximum": 416.78, "gross_charge": 2197.0, "discounted_cash": 1647.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOIMPEDANCE CV ANALYSIS", "code_information": [{"code": "93701", "type": "CPT"}], "standard_charges": [{"minimum": 45.07, "maximum": 45.07, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.07, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "478", "type": "MS-DRG"}], "standard_charges": [{"minimum": 81650.36, "maximum": 102890.47, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 81650.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 102890.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "477", "type": "MS-DRG"}], "standard_charges": [{"minimum": 114699.63, "maximum": 144537.01, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 114699.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 144537.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "479", "type": "MS-DRG"}], "standard_charges": [{"minimum": 61719.2, "maximum": 77774.52, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 61719.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 77774.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY ABDOMINAL MASS", "code_information": [{"code": "49180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2380.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY ARM/ELBOW SOFT TISSUE", "code_information": [{"code": "24065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 135.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 135.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 135.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 135.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 135.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY ARM/ELBOW SOFT TISSUE", "code_information": [{"code": "24066", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY BONE DEEP", "code_information": [{"code": "4917503", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4844.0, "discounted_cash": 3633.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY BONE DEEP", "code_information": [{"code": "5057503", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4844.0, "discounted_cash": 3633.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY BONE SUPERFICIAL", "code_information": [{"code": "4917504", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2454.0, "discounted_cash": 1840.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY BONE SUPERFICIAL", "code_information": [{"code": "5057504", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2454.0, "discounted_cash": 1840.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY BONE SUPERFICIAL", "code_information": [{"code": "6900142", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2252.0, "discounted_cash": 1689.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY BONE SUPERFICIAL", "code_information": [{"code": "6900142", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2252.0, "discounted_cash": 1689.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY EYE MUSCLE", "code_information": [{"code": "67346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 614.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 614.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 614.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 614.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 614.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY EYELID & LID MARGIN", "code_information": [{"code": "67810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY FINGER JOINT LINING", "code_information": [{"code": "26105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY FINGER JOINT LINING", "code_information": [{"code": "26110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [{"code": "25065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [{"code": "25066", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY HAND JOINT LINING", "code_information": [{"code": "26100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY KNEE JOINT LINING", "code_information": [{"code": "27330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY LOWER LEG SOFT TISSUE", "code_information": [{"code": "27613", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 131.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 131.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 131.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 131.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 131.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY LOWER LEG SOFT TISSUE", "code_information": [{"code": "27614", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY MUSCLE PERQ NEEDLE", "code_information": [{"code": "20206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY NAIL UNIT", "code_information": [{"code": "11755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF BOWEL", "code_information": [{"code": "44100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF BREAST OPEN", "code_information": [{"code": "19101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CERVIX", "code_information": [{"code": "57500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15890.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 83.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 83.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 83.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 83.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 83.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CERVIX W/SCOPE", "code_information": [{"code": "57455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6999.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 59.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 59.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 59.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 59.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 59.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CORNEA", "code_information": [{"code": "65410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EPIDIDYMIS", "code_information": [{"code": "54800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 193.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 193.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 193.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 193.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 193.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EXTERNAL EAR", "code_information": [{"code": "69100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EXTERNAL EAR CANAL", "code_information": [{"code": "69105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 91.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 91.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 91.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 91.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 91.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EYELID LINING", "code_information": [{"code": "68100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 102.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 102.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 102.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 102.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 102.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FLOOR OF MOUTH", "code_information": [{"code": "41108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 84.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 84.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 84.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 84.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 84.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28052", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HEART LINING", "code_information": [{"code": "93505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 728.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3703.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3597.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4114.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4114.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4114.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 728.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 728.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 728.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 728.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HIP JOINT", "code_information": [{"code": "27052", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF LIP", "code_information": [{"code": "40490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 68.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 68.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 68.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 68.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 68.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF MOUTH LESION", "code_information": [{"code": "40808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF NECK/CHEST", "code_information": [{"code": "21550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF NERVE", "code_information": [{"code": "64795", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF ORAL TISSUE HARD", "code_information": [{"code": "D7285", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF ORAL TISSUE SOFT", "code_information": [{"code": "D7286", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF OVARY(S)", "code_information": [{"code": "58900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PANCREAS OPEN", "code_information": [{"code": "48100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 805.12, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 805.12, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 805.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 805.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 805.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PENIS", "code_information": [{"code": "54100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PENIS", "code_information": [{"code": "54105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PROSTATE", "code_information": [{"code": "55700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 493.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 493.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 493.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 493.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 493.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PROSTATE", "code_information": [{"code": "55705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 493.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 493.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 493.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 493.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 493.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF RECTUM", "code_information": [{"code": "45100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SACROILIAC JOINT", "code_information": [{"code": "27050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND", "code_information": [{"code": "42400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND", "code_information": [{"code": "42405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SHOULDER JOINT", "code_information": [{"code": "23100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF STOMACH", "code_information": [{"code": "43605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 757.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 757.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 757.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 757.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 757.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TEAR GLAND", "code_information": [{"code": "68510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TEAR SAC", "code_information": [{"code": "68525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS", "code_information": [{"code": "54500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 606.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 606.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 606.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 606.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 606.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS", "code_information": [{"code": "54505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 23828.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF THROAT", "code_information": [{"code": "42800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF THYROID", "code_information": [{"code": "60100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TOE JOINT LINING", "code_information": [{"code": "28054", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TONGUE", "code_information": [{"code": "41100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 93.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 93.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 93.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 93.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 93.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TONGUE", "code_information": [{"code": "41105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 91.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 91.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 91.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 91.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 91.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UPPER NOSE/THROAT", "code_information": [{"code": "42804", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UPPER NOSE/THROAT", "code_information": [{"code": "42806", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF URETHRA", "code_information": [{"code": "53200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UTERUS LINING", "code_information": [{"code": "58100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINA", "code_information": [{"code": "57100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINA", "code_information": [{"code": "57105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA/PERINEUM", "code_information": [{"code": "56605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA/PERINEUM", "code_information": [{"code": "56606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF WRIST JOINT", "code_information": [{"code": "25100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OOCYTE POLAR BODY", "code_information": [{"code": "89291", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OOCYTE POLAR BODY <=5", "code_information": [{"code": "89290", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY ROOF OF MOUTH", "code_information": [{"code": "42100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 80.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 80.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 80.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 80.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 80.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY SHOULDER TISSUES", "code_information": [{"code": "23065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 100.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 100.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 100.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 100.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 100.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY SHOULDER TISSUES", "code_information": [{"code": "23066", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE OF BACK", "code_information": [{"code": "21920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 141.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 141.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 141.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 141.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 141.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE OF BACK", "code_information": [{"code": "21925", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY THIGH SOFT TISSUES", "code_information": [{"code": "27323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY THIGH SOFT TISSUES", "code_information": [{"code": "27324", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY VRT BDY OPEN LMBR/CRV", "code_information": [{"code": "20251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY VRT BDY OPEN THORACIC", "code_information": [{"code": "20250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12422.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15461.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOTINIDASE EA SPEC", "code_information": [{"code": "82261", "type": "CPT"}, {"code": "7252261", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 86.03, "gross_charge": 239.0, "discounted_cash": 179.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 86.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIPAP INITIAL", "code_information": [{"code": "94660", "type": "CPT"}, {"code": "5501857", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 60.75, "maximum": 298.43, "gross_charge": 615.0, "discounted_cash": 461.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 260.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIPAP MANAGEMENT DLY", "code_information": [{"code": "94660", "type": "CPT"}, {"code": "5504662", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 60.75, "maximum": 298.43, "gross_charge": 1218.0, "discounted_cash": 913.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 260.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIRTHING CLASS", "code_information": [{"code": "S9442", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BISOPROLOL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301605", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BISOPROLOL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301605", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BITEWINGS FOUR IMAGES", "code_information": [{"code": "D0274", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BITOLTEROL MESYLATE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7628", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.15, "maximum": 0.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BKBENCH PREP DON UTER ALGRFT", "code_information": [{"code": "668T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BKBENCH RCNSTJ DON UTER ARTL", "code_information": [{"code": "670T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BKBENCH RCNSTJ DON UTER VEN", "code_information": [{"code": "669T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BL DONOR SEARCH MANAGEMENT", "code_information": [{"code": "38204", "type": "CPT"}], "standard_charges": [{"minimum": 91.26, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 91.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 91.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 91.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 91.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 91.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BL DRAW < 3 YRS FEM/JUGULAR", "code_information": [{"code": "36400", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BL DRAW <3 YRS OTHER VEIN", "code_information": [{"code": "36406", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BL DRAW <3 YRS SCALP VEIN", "code_information": [{"code": "36405", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BL SMEAR W/O DIFF WBC COUNT", "code_information": [{"code": "85008", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17.56, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLADDER CALCULI IRRIG SOL", "code_information": [{"code": "Q2004", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLASTOMYCES AB", "code_information": [{"code": "86612", "type": "CPT"}, {"code": "7256198", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.81, "gross_charge": 389.0, "discounted_cash": 291.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD AUTOSLV INTRA/PSOP", "code_information": [{"code": "86891", "type": "CPT"}, {"code": "3216891", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 656.15, "maximum": 656.15, "gross_charge": 5019.0, "discounted_cash": 3764.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ NEWBORN", "code_information": [{"code": "36450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ OTH THN NB", "code_information": [{"code": "36455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLD LEUKO REDCD FROZEN DEGLYCE", "code_information": [{"code": "P9054", "type": "HCPCS"}, {"code": "4509054", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"gross_charge": 3188.0, "discounted_cash": 2391.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLD PROD IRRADIATION EA UNT", "code_information": [{"code": "86945", "type": "CPT"}, {"code": "4106945", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 33.84, "maximum": 33.84, "gross_charge": 595.0, "discounted_cash": 446.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD PUSH TFUJ 2 YR/<", "code_information": [{"code": "36440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLD RCELLS WASHED", "code_information": [{"code": "P9022", "type": "HCPCS"}, {"code": "4500011", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"gross_charge": 3190.0, "discounted_cash": 2392.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLD SMR EXAM W/DIFF", "code_information": [{"code": "85007", "type": "CPT"}, {"code": "4105007", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 17.56, "gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17.56, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD TYPE ABO", "code_information": [{"code": "86900", "type": "CPT"}, {"code": "4106080", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.22, "gross_charge": 165.0, "discounted_cash": 123.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.17, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD TYPE ANTIGEN DONOR EA", "code_information": [{"code": "86902", "type": "CPT"}, {"code": "4106901", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.64, "gross_charge": 462.0, "discounted_cash": 346.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 19.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD TYPE ANTIGEN DONOR EA", "code_information": [{"code": "86902", "type": "CPT"}, {"code": "7146902", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.64, "gross_charge": 215.0, "discounted_cash": 161.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 19.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD TYPE RH (D)", "code_information": [{"code": "86901", "type": "CPT"}, {"code": "4106100", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.22, "gross_charge": 108.0, "discounted_cash": 81.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.17, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD TYPE RH PHENOTYP CMP", "code_information": [{"code": "86906", "type": "CPT"}, {"code": "4106105", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 39.53, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 39.53, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD TYPE RH PHENOTYP CMP", "code_information": [{"code": "86906", "type": "CPT"}, {"code": "7146105", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 39.53, "gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 39.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD UREA NITROGEN QUAN", "code_information": [{"code": "84520", "type": "CPT"}, {"code": "4104520", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.11, "gross_charge": 130.0, "discounted_cash": 97.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEEDING TIME TEST", "code_information": [{"code": "85002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 22.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 22.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLIND COR SINUS REDUCER IMPL", "code_information": [{"code": "C9783", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLIND INTERATRIAL SHUNT IDE", "code_information": [{"code": "C9758", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 11202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLIND MYOCAR TRPL BON MARROW", "code_information": [{"code": "C9782", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 11202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLIND/NONBLIND TRANS ATRIAL", "code_information": [{"code": "C9792", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLINDED CONV. 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"type": "CPT"}, {"code": "7251209", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 39.31, "maximum": 39.31, "gross_charge": 557.0, "discounted_cash": 417.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLN COLON DILATION", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "8055090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1279.74, "maximum": 1279.74, "gross_charge": 6094.0, "discounted_cash": 4570.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLN DISSECT SPACEMAKER", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "8240010", "type": "CDM"}], "standard_charges": [{"minimum": 1279.74, "maximum": 1279.74, "gross_charge": 6094.0, "discounted_cash": 4570.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD ADMINISTRATION 1-2 UNITS", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "6290011", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 3636.0, "discounted_cash": 2727.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 763.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 3454.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 3454.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1341.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD ADMINISTRATION 3-4 UNITS", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "6290012", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 5973.0, "discounted_cash": 4479.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1254.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 5674.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 5674.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2204.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 4479.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 4479.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD ADMINISTRATION 5-6 UNITS", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "6290013", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 7990.0, "discounted_cash": 5992.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1677.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 7590.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 7590.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2948.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 5992.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 5992.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD ADMINISTRATION 7-8 UNITS", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "6290014", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 8327.0, "discounted_cash": 6245.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1748.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 7910.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 7910.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3072.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 6245.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 6245.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD ADMINISTRATION 9-10 UNIT", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "6290015", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 8455.0, "discounted_cash": 6341.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1775.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 8032.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 8032.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3119.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 6341.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 6341.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD ADMINISTRATION >10 UNITS", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "6290016", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 8721.0, "discounted_cash": 6540.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1831.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 8284.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 8284.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3218.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 6540.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 6540.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD CLOT LYSIS TIME", "code_information": [{"code": "85175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 23.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD CLOT RETRACTION", "code_information": [{"code": "85170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 191.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 191.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 151.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 151.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES O2 SAT ONLY", "code_information": [{"code": "82810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 44.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 44.53, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES W/O2 SATURATION", "code_information": [{"code": "82805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 144.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 39.65, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 39.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 39.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 39.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 39.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 78.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 78.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD HEMOGLBN", "code_information": [{"code": "85018", "type": "CPT"}, {"code": "4105018", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 12.08, "gross_charge": 71.0, "discounted_cash": 53.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3.31, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD KETONE TEST OR STRIP", "code_information": [{"code": "A4252", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLOOD MUCOPROTEIN", "code_information": [{"code": "P2038", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.95, "maximum": 4.95, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD PLATELET CONCNTRAT", "code_information": [{"code": "P9019", "type": "HCPCS"}, {"code": "4500025", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"gross_charge": 1339.0, "discounted_cash": 1004.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOOD PRODUCT IRRAND EA", "code_information": [{"code": "86945", "type": "CPT"}, {"code": "4506125", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 33.84, "maximum": 33.84, "gross_charge": 253.0, "discounted_cash": 189.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD SMEAR INTERPRETATION", "code_information": [{"code": "85060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 81.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee 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"BLOOD TYPING ANTIGEN SYSTEM", "code_information": [{"code": "86911", "type": "CPT"}], "standard_charges": [{"minimum": 23.03, "maximum": 23.03, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING PATERNITY TEST", "code_information": [{"code": "86910", "type": "CPT"}], "standard_charges": [{"minimum": 26.52, "maximum": 26.52, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.52, "methodology": "fee 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"standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD VOLUME", "code_information": [{"code": "78122", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 524.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 524.34, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 184.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 184.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 184.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 184.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 184.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD WHOLE", "code_information": [{"code": "P9010", "type": "HCPCS"}, {"code": "4500001", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"gross_charge": 730.0, "discounted_cash": 547.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOOD WHOLE AUTOLOGOUS", "code_information": [{"code": "P9010", "type": "HCPCS"}, {"code": "3219010", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 618.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLS DEFIBRILLATION SUPPLIES", "code_information": [{"code": "A0384", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BLUE LIGHT CYSTO IMAG AGENT", "code_information": [{"code": "C9738", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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"GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY OPEN DEEP", "code_information": [{"code": "6900143", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8584.0, "discounted_cash": 6438.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE BIOPSY OPEN DEEP", "code_information": [{"code": "6900143", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 8584.0, "discounted_cash": 6438.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE BIOPSY OPEN DEEP", "code_information": [{"code": "20245", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY OPEN SUPERFICIAL", "code_information": [{"code": "20240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY TROCAR/NDL DEEP", "code_information": [{"code": "20225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY TROCAR/NDL SUPFC", "code_information": [{"code": "20220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4444.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING BODY MANDIBLE", "code_information": [{"code": "D7945", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING RAMUS CLOSED", "code_information": [{"code": "D7941", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING SEGMENTED", "code_information": [{"code": "D7944", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [{"code": "553", "type": "MS-DRG"}], "standard_charges": [{"minimum": 43039.75, "maximum": 54235.9, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43039.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 54235.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [{"code": "554", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27560.98, "maximum": 34730.55, "estimated_discounted_cash": 61563.5, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27560.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34730.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE HARVEST,AUTO GRAFT PROC", "code_information": [{"code": "D7295", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAG 3 PHASE STUDY", "code_information": [{"code": "78315", "type": "CPT"}, {"code": "5208315", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1212.33, "gross_charge": 5773.0, "discounted_cash": 4329.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1212.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 725.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 359.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 359.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 359.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 359.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 359.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING LIMITED", "code_information": [{"code": "78300", "type": "CPT"}, {"code": "5208300", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 575.19, "gross_charge": 2739.0, "discounted_cash": 2054.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 575.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 368.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 185.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 185.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 185.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 185.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 185.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING MULTIPLE", "code_information": [{"code": "78305", "type": "CPT"}, {"code": "5208305", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 924.0, "gross_charge": 4400.0, "discounted_cash": 3300.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 521.82, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 252.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 252.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 252.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 252.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 252.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING WHOLE BODY", "code_information": [{"code": "78306", "type": "CPT"}, {"code": "5208307", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1035.51, "gross_charge": 4931.0, "discounted_cash": 3698.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1035.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 599.61, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 282.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 282.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 282.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 282.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 282.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE LENGTH STUDIES", "code_information": [{"code": "77073", "type": "CPT"}, {"code": "4906040", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 145.74, "gross_charge": 694.0, "discounted_cash": 520.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 145.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 96.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE LENGTH STUDIES", "code_information": [{"code": "77073", "type": "CPT"}, {"code": "5010313", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 145.74, "gross_charge": 694.0, "discounted_cash": 520.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 145.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 96.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE LENGTH STUDIES", "code_information": [{"code": "77073", "type": "CPT"}, {"code": "5057073", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 145.74, "gross_charge": 694.0, "discounted_cash": 520.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 145.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 96.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIR BONE GRFG", "code_information": [{"code": "20939", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST ALLOGEN", "code_information": [{"code": "38230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST AUTOLOG", "code_information": [{"code": "38232", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING LTD", "code_information": [{"code": "78102", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 324.88, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 170.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 170.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 170.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 170.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 170.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING MULT", "code_information": [{"code": "78103", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 472.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 472.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 235.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 235.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 235.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 235.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 235.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMG WH/BODY", "code_information": [{"code": "78104", "type": "CPT"}, {"code": "5208104", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 589.58, "gross_charge": 2769.0, "discounted_cash": 2076.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 581.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 589.58, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 278.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 278.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 278.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 278.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 278.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW INTERPRETATION", "code_information": [{"code": "85097", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 656.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 175.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL DUAL PHOTON", "code_information": [{"code": "78351", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 48.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 48.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL SINGLE PHOTON", "code_information": [{"code": "78350", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 100.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 100.36, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE PUTTY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8031657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 828.66, "maximum": 828.66, "gross_charge": 3946.0, "discounted_cash": 2959.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 828.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SRGRY CMPTR CT/MRI IMAG", "code_information": [{"code": "55T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE SRGRY CMPTR FLUOR IMAGE", "code_information": [{"code": "54T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE SURVEY COMPLETE", "code_information": [{"code": "77075", "type": "CPT"}, {"code": "4906063", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 337.26, "gross_charge": 1606.0, "discounted_cash": 1204.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 337.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 208.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SURVEY COMPLETE", "code_information": [{"code": "77075", "type": "CPT"}, {"code": "5016063", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 337.26, "gross_charge": 1606.0, "discounted_cash": 1204.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 337.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 208.23, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SURVEY INFANT", "code_information": [{"code": "77076", "type": "CPT"}, {"code": "4906065", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 240.87, "gross_charge": 1147.0, "discounted_cash": 860.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 240.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 129.19, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 97.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 97.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 97.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 97.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 97.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SURVEY INFANT", "code_information": [{"code": "77076", "type": "CPT"}, {"code": "5016065", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 240.87, "gross_charge": 1147.0, "discounted_cash": 860.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 240.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 129.19, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 97.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 97.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 97.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 97.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 97.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SURVEY LIMITED", "code_information": [{"code": "77074", "type": "CPT"}, {"code": "4906060", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 345.24, "gross_charge": 1644.0, "discounted_cash": 1233.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 345.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 139.25, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SURVEY LIMITED", "code_information": [{"code": "77074", "type": "CPT"}, {"code": "5016060", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 345.24, "gross_charge": 1644.0, "discounted_cash": 1233.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 345.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 139.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT GREAT TOE", "code_information": [{"code": "20973", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT ILIAC CREST", "code_information": [{"code": "20970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2775.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2775.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2775.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2775.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2775.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT METATARSAL", "code_information": [{"code": "20972", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT MICROVASC", "code_information": [{"code": "20969", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2783.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2783.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2783.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2783.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2783.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BOOT/SHOE SURGICAL", "code_information": [{"code": "L3260", "type": "HCPCS"}, {"code": "8131331", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"minimum": 25.24, "maximum": 28.86, "gross_charge": 565.0, "discounted_cash": 423.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORDETELLA AB", "code_information": [{"code": "86615", "type": "CPT"}, {"code": "7050013", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "gross_charge": 146.0, "discounted_cash": 109.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORDETELLA AB", "code_information": [{"code": "86615", "type": "CPT"}, {"code": "7256924", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "gross_charge": 75.0, "discounted_cash": 56.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORDETELLA AB/3", "code_information": [{"code": "86615", "type": "CPT"}, {"code": "7256929", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "gross_charge": 75.0, "discounted_cash": 56.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORRELIA AB/2", "code_information": [{"code": "86619", "type": "CPT"}, {"code": "7256642", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.22, "gross_charge": 189.0, "discounted_cash": 141.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 68.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.69, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORRELIA MIYAMOTOI AMP PRB", "code_information": [{"code": "87478", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 35.09, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORTEZOMIB (FRESENIUS) .1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9048", "type": "HCPCS"}, {"code": "5318648", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 46.99, "maximum": 52.21, "gross_charge": 90.0, "discounted_cash": 67.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORTEZOMIB (FRESENIUS) .1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9048", "type": "HCPCS"}, {"code": "5318648", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 46.99, "maximum": 52.21, "gross_charge": 90.0, "discounted_cash": 67.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOTULINUM ANTITOXIN", "code_information": [{"code": "90287", "type": "CPT"}], "standard_charges": [{"minimum": 3.58, "maximum": 3.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOTULINUM TOXIN A PERUIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0585", "type": "HCPCS"}, {"code": "5318651", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 5.85, "maximum": 6.5, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOTULINUM TOXIN A PERUIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0585", "type": "HCPCS"}, {"code": "5318651", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.85, "maximum": 6.5, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOTULISM IG IV", "code_information": [{"code": "90288", "type": "CPT"}], "standard_charges": [{"minimum": 3.58, "maximum": 3.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOWEL EVACUANT KIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5339247", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 397.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWEL EVACUANT KIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5339247", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 397.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWEL EVACUANT KIT 2L LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314383", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 108.0, "discounted_cash": 81.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWEL EVACUANT KIT 2L LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314383", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 108.0, "discounted_cash": 81.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWEL EVACUANT KT354MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314385", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 384.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWEL EVACUANT KT354MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314385", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 384.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWEL TO BOWEL FUSION", "code_information": [{"code": "44130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1133.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1133.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1133.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1133.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1133.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BP NOT PERFORMED/DOC", "code_information": [{"code": "G8478", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BP OUT OF NRML LIMITS", "code_information": [{"code": "G9274", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BP SCRN NO PERF AT INTERVAL", "code_information": [{"code": "G8785", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BP SCRN PERF REC INTERVAL", "code_information": [{"code": "G8783", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BP SYS <140 AND DIAS <90", "code_information": [{"code": "G8476", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BP SYS>=140 AND/OR DIAS >=90", "code_information": [{"code": "G8477", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BPCI HOME VISIT", "code_information": [{"code": "G9187", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHY LINEAR, NON-STR,P-103", "code_information": [{"code": "C2636", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHY,NON-STR,YTTERBIUM-169", "code_information": [{"code": "C2637", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTHERAPY NEEDLE", "code_information": [{"code": "C1715", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTHERAPY RADIOELEMENTS", "code_information": [{"code": "Q3001", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.91, "maximum": 96.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 86.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 96.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 96.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 96.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 96.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISO PLAN CMPLX", "code_information": [{"code": "77318", "type": "CPT"}, {"code": "5107328", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1279.75, "gross_charge": 4223.0, "discounted_cash": 3167.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1279.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 501.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISO PLAN INTRMD", "code_information": [{"code": "77317", "type": "CPT"}, {"code": "5107327", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 885.62, "gross_charge": 5765.0, "discounted_cash": 4323.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 885.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 501.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISO PLAN SIMPLE", "code_information": [{"code": "77316", "type": "CPT"}, {"code": "5107326", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 679.38, "gross_charge": 2072.0, "discounted_cash": 1554.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 435.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 679.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 501.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX PLANAR, P-103", "code_information": [{"code": "C2645", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.25, "maximum": 8.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR, GOLD-198", "code_information": [{"code": "C1716", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR, HA, I-125", "code_information": [{"code": "C2634", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR, HA, P-103", "code_information": [{"code": "C2635", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.3, "maximum": 46.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 46.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 46.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 46.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 46.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR,HDR IR-192", "code_information": [{"code": "C1717", "type": "HCPCS"}], "standard_charges": [{"minimum": 453.56, "maximum": 503.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 453.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 503.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 503.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 503.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 503.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR,YTTRIUM-90", "code_information": [{"code": "C2616", "type": "HCPCS"}], "standard_charges": [{"minimum": 25933.24, "maximum": 28804.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25933.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 28804.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28804.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28804.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28804.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED, NOS", "code_information": [{"code": "C2699", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED,C-131", "code_information": [{"code": "C2643", "type": "HCPCS"}], "standard_charges": [{"minimum": 122.23, "maximum": 135.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 122.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 135.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 135.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 135.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 135.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED,I-125", "code_information": [{"code": "C2639", "type": "HCPCS"}], "standard_charges": [{"minimum": 54.61, "maximum": 60.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 54.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED,P-103", "code_information": [{"code": "C2641", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NS, NON-HDRIR-192", "code_information": [{"code": "C1719", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, C-131", "code_information": [{"code": "C2642", "type": "HCPCS"}], "standard_charges": [{"minimum": 124.7, "maximum": 138.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 124.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 138.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 138.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 138.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 138.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, NOS", "code_information": [{"code": "C2698", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, P-103", "code_information": [{"code": "C2640", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAF V600E VARIANT", "code_information": [{"code": "81210", "type": "CPT"}, {"code": "7270012", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 670.98, "gross_charge": 1691.0, "discounted_cash": 1268.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 670.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61697", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3847.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3847.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3847.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3847.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3847.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61698", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4065.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4065.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4065.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4065.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4065.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR SIMPLE", "code_information": [{"code": "61700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3305.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3305.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3305.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3305.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3305.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN BIOPSY W/CT/MR GUIDE", "code_information": [{"code": "61751", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1284.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1284.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1284.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1284.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1284.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN CANAL SHUNT PROCEDURE", "code_information": [{"code": "61070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN CAVITY SHUNT W/SCOPE", "code_information": [{"code": "62201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1108.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1108.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1108.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1108.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1108.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAG VASC FLO ONLY", "code_information": [{"code": "78610", "type": "CPT"}, {"code": "5208610", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 741.93, "gross_charge": 3533.0, "discounted_cash": 2649.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 741.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 289.76, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 208.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 208.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 208.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 208.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 208.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE 4+ VIEWS", "code_information": [{"code": "78605", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 489.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 477.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 218.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 218.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 218.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 218.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 218.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 319.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 319.48, "methodology": "fee 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"billing_class": "facility"}]}, {"description": "BRCA1&2 185&5385&6174 VRNT", "code_information": [{"code": "81212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 661.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 661.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 440.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GEN FUL DUP/DEL ALYS", "code_information": [{"code": "81164", "type": "CPT"}], "standard_charges": [{"minimum": 584.23, "maximum": 584.23, "setting": "outpatient", 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{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST AUGMENTATION W/IMPLT", "code_information": [{"code": "19325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "estimated_discounted_cash": 40098.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC", "code_information": [{"code": "584", "type": "MS-DRG"}], "standard_charges": [{"minimum": 71075.52, "maximum": 89564.75, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 71075.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 89564.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "585", "type": "MS-DRG"}], "standard_charges": [{"minimum": 64049.98, "maximum": 80711.61, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64049.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80711.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST CANCER DX MIN INVSIVE", "code_information": [{"code": "G8875", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BREAST DIEP OR SIEA FLAP", "code_information": [{"code": "S2068", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST GAP FLAP RECONST", "code_information": [{"code": "S2066", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST RECONSTRUCTION", "code_information": [{"code": "19350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST REDUCTION", "code_information": [{"code": "19318", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 43778.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREATH HYDROGEN/METHANE TEST", "code_information": [{"code": "91065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 72.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 72.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 72.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 72.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 72.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREATH TEST ANALYSIS C-14", "code_information": [{"code": "78268", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 311.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 311.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 94.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 94.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH TST ATTAIN/ANAL C-14", "code_information": [{"code": "78267", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 36.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 36.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRENTUXIMAB VEDOTIN INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9042", "type": "HCPCS"}], "standard_charges": [{"minimum": 232.78, "maximum": 258.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 232.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 258.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 258.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 258.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 258.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF ALCOHOL MISUSE COUNSEL", "code_information": [{"code": "G0443", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIEF CHECK IN BY MD/QHP", "code_information": [{"code": "G2012", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRIEF CHKIN BY MD/QHP, 11-20", "code_information": [{"code": "G2252", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.89, "maximum": 52.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 47.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 45.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF CHKIN, 5-10, NON-E/M", "code_information": [{"code": "G2251", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.0, "maximum": 27.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF EMOTIONAL/BEHAV ASSMT", "code_information": [{"code": "96127", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PLM NRV UNI", "code_information": [{"code": "782T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PULM NRV BI", "code_information": [{"code": "781T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR 1ST", "code_information": [{"code": "31645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR SBSQ", "code_information": [{"code": "31646", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BROMOCRIPTINE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301680", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BROMOCRIPTINE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301680", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BROMPHENIRAMINE MALEATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0945", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.72, "maximum": 0.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH ASPIRATN INITIAL", "code_information": [{"code": "5500671", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7060.0, "discounted_cash": 5295.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRONCH EBUS IVNTJ PERPH LES", "code_information": [{"code": "31654", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 1/2 NODE", "code_information": [{"code": "31652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 24912.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 3/> NODE", "code_information": [{"code": "31653", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH EVAL W/MULT SPIRO", "code_information": [{"code": "94070", "type": "CPT"}, {"code": "5501180", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 65.81, "maximum": 392.98, "gross_charge": 2055.0, "discounted_cash": 1541.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH LAVAGE W/EBUS", "code_information": [{"code": "C7556", "type": "HCPCS"}], "standard_charges": [{"minimum": 4898.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 1 LOBE", "code_information": [{"code": "31660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 2/> LOBES", "code_information": [{"code": "31661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH W/BALLOON OCCLUSION", "code_information": [{"code": "31634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ EBUS", "code_information": [{"code": "C7512", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ NAVIGATION", "code_information": [{"code": "C7511", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH/LAVAG W/ NAVIGATION", "code_information": [{"code": "C7510", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL ALLERGY TESTS", "code_information": [{"code": "95070", "type": "CPT"}], "standard_charges": [{"minimum": 71.94, "maximum": 709.1, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 71.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 71.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 71.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 71.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 71.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL BRUSH BIOPSY", "code_information": [{"code": "31717", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE ADDL INSERT", "code_information": [{"code": "31651", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE INIT INSERT", "code_information": [{"code": "31647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV ADDL", "code_information": [{"code": "31649", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV INIT", "code_information": [{"code": "31648", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITH CC/MCC", "code_information": [{"code": "202", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32245.78, "maximum": 40634.04, "estimated_discounted_cash": 54207.85, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32245.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40634.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITHOUT CC/MCC", "code_information": [{"code": "203", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3810.67, "maximum": 28032.13, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8968.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13222.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10608.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19637.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20662.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11162.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9437.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13913.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14692.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21819.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9965.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11787.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11787.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21819.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9965.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14692.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11787.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9965.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14692.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21819.33, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 3810.67, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7421.74, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4992.62, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 17584.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22245.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28032.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY BRONCH STENTS", "code_information": [{"code": "31636", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DIAGNOSTIC", "code_information": [{"code": "5500655", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 992.0, "discounted_cash": 744.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE W/STENT", "code_information": [{"code": "31631", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE/FX REPR", "code_information": [{"code": "31630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DX W/BRSH", "code_information": [{"code": "5501011", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6857.0, "discounted_cash": 5142.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY REVISE STENT", "code_information": [{"code": "31638", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY STENT ADD-ON", "code_information": [{"code": "31637", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY TREAT BLOCKAGE", "code_information": [{"code": "31641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W BIOPSY", "code_information": [{"code": "5500660", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2669.0, "discounted_cash": 2001.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/BIOPSY(S)", "code_information": [{"code": "31625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 13454.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/FB REMOVAL", "code_information": [{"code": "31635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/MARKERS", "code_information": [{"code": "31626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/TUMOR EXCISE", "code_information": [{"code": "31640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1075.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX ADDL", "code_information": [{"code": "31632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX EACH", "code_information": [{"code": "31628", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX ADDL", "code_information": [{"code": "31633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX EACH", "code_information": [{"code": "31629", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSPASM EVAL", "code_information": [{"code": "94060", "type": "CPT"}, {"code": "6704060", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 67.46, "maximum": 392.98, "gross_charge": 1017.0, "discounted_cash": 762.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 67.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 67.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 67.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 67.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 67.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSPASM EVAL PRE/PS", "code_information": [{"code": "94060", "type": "CPT"}, {"code": "5501201", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 67.46, "maximum": 392.98, "gross_charge": 1017.0, "discounted_cash": 762.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 67.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 67.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 67.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 67.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 67.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHSCPY ALVEOLAR LVG", "code_information": [{"code": "5501012", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4867.0, "discounted_cash": 3650.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BRST CNCR STAGE > T1N0M0", "code_information": [{"code": "G8881", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 1 PDCL TRAM FLAP", "code_information": [{"code": "19367", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1763.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1763.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1763.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1763.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1763.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 1PDCL TRAM ANAST", "code_information": [{"code": "19368", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2164.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2164.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2164.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2164.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2164.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 2 PDCL TRAM FLAP", "code_information": [{"code": "19369", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1993.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1993.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1993.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1993.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1993.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ FREE FLAP", "code_information": [{"code": "19364", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2687.37, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2687.37, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2687.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2687.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2687.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ LATSMS DRSI FLAP", "code_information": [{"code": "19361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1551.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1551.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1551.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1551.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1551.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRUCELLA AB", "code_information": [{"code": "86622", "type": "CPT"}, {"code": "7256622", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.55, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 45.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRUCELLA AB/2", "code_information": [{"code": "86622", "type": "CPT"}, {"code": "7256628", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.55, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 45.55, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRUCELLA AB/3", "code_information": [{"code": "86622", "type": "CPT"}, {"code": "7256635", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.55, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 45.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BSO OMENTECTOMY W/TAH", "code_information": [{"code": "58956", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1328.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1328.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1328.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1328.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1328.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BTK GENE COMMON VARIANTS", "code_information": [{"code": "81233", "type": "CPT"}], "standard_charges": [{"minimum": 175.4, "maximum": 175.4, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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"5301745", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPROPION HCL SR 60 TABLETS", "code_information": [{"code": "S0106", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.8, "maximum": 17.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURR HOLE FOR PUNCTURE", "code_information": [{"code": "61120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 682.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 682.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 682.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 682.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 682.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUSPIRONE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301761", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BUSPIRONE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301761", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BUSPIRONE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301760", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BUSPIRONE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301760", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BUSULFAN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0594", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.79, "maximum": 0.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTORPHANOL TARTRATE, NASAL", "code_information": [{"code": "S0012", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.21, "maximum": 69.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 62.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 69.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 69.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 69.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 69.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY", "code_information": [{"code": "27027", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY W/DBRDMT", "code_information": [{"code": "27057", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUTTON ARTHRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8172896", "type": "CDM"}], "standard_charges": [{"minimum": 444.36, "maximum": 444.36, "gross_charge": 2116.0, "discounted_cash": 1587.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 444.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX ABD/RETROPER PERC NDL", "code_information": [{"code": "4917502", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 2692.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX ABD/RETROPER PERC NDL", "code_information": [{"code": "5057502", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 2692.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX ABD/RETROPER PERC NDL", "code_information": [{"code": "5067530", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 2692.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX ADRENAL GLAND", "code_information": [{"code": "5056069", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21674.0, "discounted_cash": 16255.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX ARM/ELBOW SOFT TISSUE", "code_information": [{"code": "5062067", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8671.0, "discounted_cash": 6503.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BONE SPRFICIAL OPEN", "code_information": [{"code": "6909897", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12781.0, "discounted_cash": 9585.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BONE SPRFICIAL OPEN", "code_information": [{"code": "6909897", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 12781.0, "discounted_cash": 9585.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION MR IMAG", "code_information": [{"code": "19085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION STRTCTC", "code_information": [{"code": "19081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1374.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION US IMAG", "code_information": [{"code": "19083", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 16002.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION MR IMAG", "code_information": [{"code": "19086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION STRTCTC", "code_information": [{"code": "19082", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5760.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION US IMAG", "code_information": [{"code": "19084", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17471.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST PERCUT W/O IMAGE", "code_information": [{"code": "19100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1366.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 193.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 193.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 193.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 193.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 193.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BRST 1ST LESION MR", "code_information": [{"code": "5259185", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7287.0, "discounted_cash": 5465.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BRST 1ST LESION STRTC", "code_information": [{"code": "3079081", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10811.0, "discounted_cash": 8108.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BRST 1ST LESION STRTC", "code_information": [{"code": "5019081", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10811.0, "discounted_cash": 8108.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BRST 1ST LESION US", "code_information": [{"code": "3079183", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12821.0, "discounted_cash": 9615.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BRST 1ST LESION US", "code_information": [{"code": "5019183", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17471.0, "discounted_cash": 13103.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BRST 1ST LESION US", "code_information": [{"code": "5069183", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19043.0, "discounted_cash": 14282.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BRST ADD LESION MR", "code_information": [{"code": "5259186", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7887.0, "discounted_cash": 5915.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BRST ADD LESION STRTC", "code_information": [{"code": "3079182", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BRST ADD LESION STRTC", "code_information": [{"code": "5019182", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4000.0, "discounted_cash": 3000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BRST ADD LESION US", "code_information": [{"code": "3079184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8352.0, "discounted_cash": 6264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BRST ADD LESION US", "code_information": [{"code": "5019184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7662.0, "discounted_cash": 5746.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BRST ADD LESION US", "code_information": [{"code": "5069184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6308.0, "discounted_cash": 4731.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX DONE W/COLPOSCOPY ADD-ON", "code_information": [{"code": "58110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 50.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 50.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 50.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 50.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 50.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX LIVER PERC NDL", "code_information": [{"code": "4918215", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 2692.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX LIVER PERC NDL", "code_information": [{"code": "5058215", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 2692.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX LIVER PERC NDL", "code_information": [{"code": "5067520", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3590.0, "discounted_cash": 2692.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX LUNG/MEDIAST PERC NDL", "code_information": [{"code": "4917510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5556.0, "discounted_cash": 4167.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX LUNG/MEDIAST PERC NDL", "code_information": [{"code": "5057510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5556.0, "discounted_cash": 4167.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX MUSCLE PERC NDL", "code_information": [{"code": "4917511", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2470.0, "discounted_cash": 1852.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX MUSCLE PERC NDL", "code_information": [{"code": "5057511", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2470.0, "discounted_cash": 1852.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX MUSCLE PERC NDL", "code_information": [{"code": "5067515", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2470.0, "discounted_cash": 1852.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX OF CERVIX W/SCOPE LEEP", "code_information": [{"code": "57460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12927.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 186.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 186.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 186.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 186.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 186.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX PANCREAS PERC NDL", "code_information": [{"code": "4917512", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5708.0, "discounted_cash": 4281.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX PANCREAS PERC NDL", "code_information": [{"code": "5057512", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5708.0, "discounted_cash": 4281.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX PLEURA PERC NDL", "code_information": [{"code": "4917505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4440.0, "discounted_cash": 3330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX PLEURA PERC NDL", "code_information": [{"code": "5057505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4440.0, "discounted_cash": 3330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX RENAL PERC NDL", "code_information": [{"code": "4917514", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5118.0, "discounted_cash": 3838.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX RENAL PERC NDL", "code_information": [{"code": "5057514", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6860.0, "discounted_cash": 5145.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX RENAL PERC NDL", "code_information": [{"code": "5067535", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6860.0, "discounted_cash": 5145.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX SALIVARY GLAND NDL", "code_information": [{"code": "5062400", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2121.0, "discounted_cash": 1590.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BX SFT TISS BC/FLNK SUPFICIL", "code_information": [{"code": "4911920", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5966.0, "discounted_cash": 4474.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX SFT TISS BCK/FLNK SUPFICIL", "code_information": [{"code": "5051921", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5966.0, "discounted_cash": 4474.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX SFT TISS LEG/ANKLE DEEP", "code_information": [{"code": "5057614", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12127.0, "discounted_cash": 9095.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX SOFT PELVIS/HIP SPFC", "code_information": [{"code": "5067040", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7302.0, "discounted_cash": 5476.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX SOFT TISS LEG/ANKLE DEEP", "code_information": [{"code": "5067614", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12127.0, "discounted_cash": 9095.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX SOFT TISSUE NECK/THOR", "code_information": [{"code": "5058575", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5279.0, "discounted_cash": 3959.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX SOFT TISSUE NECK/THOR", "code_information": [{"code": "5068575", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5279.0, "discounted_cash": 3959.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX THYROID PERC NDL", "code_information": [{"code": "4917509", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3737.0, "discounted_cash": 2802.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BX THYROID PERC NDL", "code_information": [{"code": "5067545", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3737.0, "discounted_cash": 2802.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BX/CURETT OF CERVIX W/SCOPE", "code_information": [{"code": "57454", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6999.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 55.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 55.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 55.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 55.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 55.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN CERVL", "code_information": [{"code": "63285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2445.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2445.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2445.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2445.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2445.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN THRC", "code_information": [{"code": "63286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2445.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2445.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2445.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2445.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2445.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN THRLMB", "code_information": [{"code": "63287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2567.18, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2567.18, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2567.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2567.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2567.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN CRVL", "code_information": [{"code": "63280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1988.64, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1988.64, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1988.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1988.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1988.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN LMBR", "code_information": [{"code": "63282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1857.48, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1857.48, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1857.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1857.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1857.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN SCRL", "code_information": [{"code": "63283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1772.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1772.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1772.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1772.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1772.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN THRC", "code_information": [{"code": "63281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1971.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1971.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1971.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1971.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1971.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN CRVL", "code_information": [{"code": "63275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1686.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1686.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1686.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1686.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1686.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN LMBR", "code_information": [{"code": "63277", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1477.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1477.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1477.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1477.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1477.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN SCRL", "code_information": [{"code": "63278", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1447.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1447.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1447.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1447.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1447.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN THRC", "code_information": [{"code": "63276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1674.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1674.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1674.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1674.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1674.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL/IDRL LSN ANY LVL", "code_information": [{"code": "63290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2577.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2577.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2577.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2577.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2577.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BYPASS GRAFT PATENCY/PATCH", "code_information": [{"code": "35685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 208.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 208.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 208.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 208.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 208.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BYPASS GRAFT/AV FIST PATENCY", "code_information": [{"code": "35686", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 173.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 173.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 173.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 173.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 173.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Back pain measures grp", "code_information": [{"code": "G8493", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Back pain mg qual act perfrm", "code_information": [{"code": "G8502", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Bblock contraind", "code_information": [{"code": "G8583", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Bblock disch", "code_information": [{"code": "G8582", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Accommodations General", "code_information": [{"code": "1000", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Accommodations Group Home", "code_information": [{"code": "1005", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Accommodations Halfway House", "code_information": [{"code": "1004", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Accommodations Residential Treatment - Chemical Dependency", "code_information": [{"code": "1002", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Accommodations Residential Treatment - Psychiatric", "code_information": [{"code": "1001", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Accommodations Supervised Living", "code_information": [{"code": "1003", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Treatment Services, 090x Extension: Individual Therapy", "code_information": [{"code": "914", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 410.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA BEHAVIORAL HEALTH COMMERCIAL/HIX", "standard_charge_dollar": 410.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", 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{"description": "Behavioral Health Treatment Services, 090x Extension: Partial Hospitalization, Less Intensive", "code_information": [{"code": "912", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 480.0, "setting": "outpatient", "payers_information": [{"payer_name": "MAGELLAN", "plan_name": "MAGELLAN BEHAVIORAL HEALTH", "standard_charge_dollar": 480.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Treatment Services, 090x Extension: Rehabilitation", "code_information": [{"code": "911", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": 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{"description": "C MOTOR EVOKED UPR&LWR LIMBS", "code_information": [{"code": "95939", "type": "CPT"}], "standard_charges": [{"minimum": 1243.2, "maximum": 1421.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1243.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}], "billing_class": 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-1 ESTERASE, CINRYZE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0598", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.07, "maximum": 65.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 59.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 65.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 65.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 65.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 65.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LAMINOPLASTY W/GRAFT/PLATE", "code_information": [{"code": "63051", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1617.79, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1617.79, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1617.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1617.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1617.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG CORNEOSCLRL LENS", "code_information": [{"code": "92313", "type": "CPT"}], "standard_charges": [{"minimum": 89.09, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH APHAKIA 1", "code_information": [{"code": "92315", "type": "CPT"}], "standard_charges": [{"minimum": 65.37, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH APHAKIA OU", "code_information": [{"code": "92316", "type": "CPT"}], "standard_charges": [{"minimum": 76.13, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 82.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 82.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 82.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 82.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 82.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH CORNEOSCLRL", "code_information": [{"code": "92317", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH OU", "code_information": [{"code": "92314", "type": "CPT"}], "standard_charges": [{"minimum": 69.63, "maximum": 79.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 69.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 79.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 79.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 79.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-PEPTIDE", "code_information": [{"code": "84681", "type": "CPT"}, {"code": "7253976", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 106.11, "gross_charge": 377.0, "discounted_cash": 282.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 106.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.07, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-REACTIVE PROTEIN", "code_information": [{"code": "86140", "type": "CPT"}, {"code": "4106021", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 190.0, "discounted_cash": 142.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C/R EXER W/ ECG", "code_information": [{"code": "93798", "type": "CPT"}, {"code": "6010152", "type": "CDM"}, {"code": "943", "type": "RC"}], "standard_charges": [{"minimum": 30.57, "maximum": 184.02, "gross_charge": 513.0, "discounted_cash": 384.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 165.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 160.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 184.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 184.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 184.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C/R EXER W/O ECG", "code_information": [{"code": "93797", "type": "CPT"}, {"code": "6010153", "type": "CDM"}, {"code": "943", "type": "RC"}], "standard_charges": [{"minimum": 20.71, "maximum": 184.02, "gross_charge": 513.0, "discounted_cash": 384.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 165.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 160.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 184.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 184.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 184.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C/T FACET INJ+IMAGE LV3+", "code_information": [{"code": "4904492", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2687.0, "discounted_cash": 2015.25, "setting": "both", "billing_class": "facility"}]}, {"description": "C/T FACET INJ+IMAGE LV3+", "code_information": [{"code": "4914492", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2687.0, "discounted_cash": 2015.25, "setting": "both", "billing_class": "facility"}]}, {"description": "C/T FACET INJ+IMAGE LVL1", "code_information": [{"code": "4904490", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7572.0, "discounted_cash": 5679.0, "setting": "both", "billing_class": "facility"}]}, {"description": "C/T FACET INJ+IMAGE LVL1", "code_information": [{"code": "4914490", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7572.0, "discounted_cash": 5679.0, "setting": "both", "billing_class": "facility"}]}, {"description": "C/T FACET INJ+IMAGE LVL2", "code_information": [{"code": "4904491", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2687.0, "discounted_cash": 2015.25, "setting": "both", "billing_class": "facility"}]}, {"description": "C/T FACET INJ+IMAGE LVL2", "code_information": [{"code": "4914491", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2687.0, "discounted_cash": 2015.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CA SCREEN;FLEXI SIGMOIDSCOPE", "code_information": [{"code": "G0104", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7557.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CA SCREEN;PELVIC/BREAST EXAM", "code_information": [{"code": "G0101", "type": "HCPCS"}], "standard_charges": [{"minimum": 104.05, "maximum": 118.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 104.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 118.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 118.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 118.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABAZITAXEL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9043", "type": "HCPCS"}], "standard_charges": [{"minimum": 204.55, "maximum": 227.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 204.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 227.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 227.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 227.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 227.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABERGOLINE, ORAL 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8515", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.61, "maximum": 1.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ART-VEIN SIX OR MORE", "code_information": [{"code": "33523", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 827.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 827.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 827.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 827.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 827.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL FOUR OR MORE", "code_information": [{"code": "33536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2633.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2633.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2633.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2633.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2633.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL SINGLE", "code_information": [{"code": "33533", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1953.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1953.59, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1953.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1953.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1953.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL THREE", "code_information": [{"code": "33535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2467.53, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2467.53, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2467.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2467.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2467.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL TWO", "code_information": [{"code": "33534", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2246.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2246.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2246.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2246.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2246.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FIVE", "code_information": [{"code": "33522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 721.17, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 721.17, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 721.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 721.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 721.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FOUR", "code_information": [{"code": "33521", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 628.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 628.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 628.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 628.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 628.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN SINGLE", "code_information": [{"code": "33517", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 179.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 179.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 179.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 179.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 179.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN THREE", "code_information": [{"code": "33519", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 514.99, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 514.99, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 514.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 514.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 514.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN TWO", "code_information": [{"code": "33518", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 383.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 383.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 383.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 383.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 383.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FIVE", "code_information": [{"code": "33514", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2595.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2595.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2595.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2595.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2595.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FOUR", "code_information": [{"code": "33513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2478.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2478.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2478.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2478.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2478.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SINGLE", "code_information": [{"code": "33510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1996.15, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1996.15, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1996.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1996.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1996.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SIX OR MORE", "code_information": [{"code": "33516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2695.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2695.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2695.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2695.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2695.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG VEIN THREE", "code_information": [{"code": "33512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2410.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2410.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2410.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2410.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2410.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG VEIN TWO", "code_information": [{"code": "33511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2164.69, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2164.69, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2164.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2164.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2164.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABLE DALL MILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8173000", "type": "CDM"}], "standard_charges": [{"minimum": 623.49, "maximum": 623.49, "gross_charge": 2969.0, "discounted_cash": 2226.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 623.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACL PER 2MG PFS IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0618", "type": "HCPCS"}, {"code": "5318804", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.1, "discounted_cash": 0.08, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACL PER 2MG PFS IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0618", "type": "HCPCS"}, {"code": "5318804", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.1, "discounted_cash": 0.08, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACNA1A FULL GENE ANALYSIS", "code_information": [{"code": "231U", "type": "CPT"}], "standard_charges": [{"minimum": 846.27, "maximum": 846.27, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 846.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 846.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACNA1A GEN DETC ABNOR ALLEL", "code_information": [{"code": "81184", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACNA1A GEN KNOWN FAMIL VRNT", "code_information": [{"code": "81186", "type": "CPT"}], "standard_charges": [{"minimum": 185.2, "maximum": 185.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACNA1A GENE FULL GENE SEQ", "code_information": [{"code": "81185", "type": "CPT"}], "standard_charges": [{"minimum": 846.27, "maximum": 846.27, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 846.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 846.27, "methodology": "fee 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAD CXR WITH INTERP", "code_information": [{"code": "174T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CADMIUM", "code_information": [{"code": "82300", "type": "CPT"}, {"code": "7252300", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 118.0, "gross_charge": 615.0, "discounted_cash": 461.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 118.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAFFEINE QUANT", "code_information": [{"code": "80155", "type": "CPT"}, {"code": "7252312", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.23, "gross_charge": 313.0, "discounted_cash": 234.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 72.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALC BMI ABV UP PARAM F/U", "code_information": [{"code": "G8417", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALC BMI BLW LOW PARAM F/U", "code_information": [{"code": "G8418", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALC BMI NORM PARAMETERS", "code_information": [{"code": "G8420", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALC BMI OUT NRM PARAM NOF/U", "code_information": [{"code": "G8419", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALCITONIN", "code_information": [{"code": "82308", "type": "CPT"}, {"code": "7252308", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 136.55, "gross_charge": 291.0, "discounted_cash": 218.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 136.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.41, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCITONIN SALMON INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0630", "type": "HCPCS"}], "standard_charges": [{"minimum": 820.8, "maximum": 912.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 820.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 912.0, "methodology": "fee 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"AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 112.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 112.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 112.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 112.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 112.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCITRIOL .25MCG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301791", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CALCITRIOL .25MCG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301791", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CALCITROL", "code_information": [{"code": "S0169", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALCIUM", "code_information": [{"code": "82310", "type": "CPT"}, {"code": "4102310", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.28, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCIUM INFUSION TEST", "code_information": [{"code": "82331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCIUM IONIZED", "code_information": [{"code": "82330", "type": "CPT"}, {"code": "4102330", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.68, "gross_charge": 296.0, "discounted_cash": 222.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.68, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCIUM IONIZED", "code_information": [{"code": "82330", "type": "CPT"}, {"code": "7252330", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.68, "gross_charge": 201.0, "discounted_cash": 150.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCIUM URINE QUAN/2", "code_information": [{"code": "82340", "type": "CPT"}, {"code": "4102341", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.77, "gross_charge": 143.0, "discounted_cash": 107.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 30.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCULUS ANALYSIS QUAL", "code_information": [{"code": "82355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 59.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 59.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.17, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.17, "methodology": "fee 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"standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCULUS QUAN", "code_information": [{"code": "82360", "type": "CPT"}, {"code": "4309900", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.66, "gross_charge": 379.0, "discounted_cash": 284.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.66, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCULUS QUAN", "code_information": [{"code": "82360", "type": "CPT"}, {"code": "7012360", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.66, "gross_charge": 301.0, "discounted_cash": 225.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.66, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALIBRATED MICROCAP TUBE", "code_information": [{"code": "A4651", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALORIC VSTBLR TEST W/REC", "code_information": [{"code": "92538", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO 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{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALR EXON 9 VARIANTS", "code_information": [{"code": "81219", "type": "CPT"}, {"code": "7251220", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 621.16, "gross_charge": 2270.0, "discounted_cash": 1702.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 621.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 121.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 121.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAM CERVIX UTERI DRG COLP", "code_information": [{"code": "57465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAMISOLE POST-MAST", "code_information": [{"code": "S8460", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAMPYLOBACTER ANTIBODY", "code_information": [{"code": "86625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 141.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 141.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANALITH REPOSITIONING PROC", "code_information": [{"code": "95992", "type": "CPT"}], "standard_charges": [{"minimum": 74.41, "maximum": 85.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 76.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 74.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 85.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 85.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 85.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANCER TREATMENT PLAN CHANGE", "code_information": [{"code": "S0354", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANCER TREATMENTPLAN INITIAL", "code_information": [{"code": "S0353", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CANDIDA AB", "code_information": [{"code": "86628", "type": "CPT"}, {"code": "7256049", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.25, "gross_charge": 191.0, "discounted_cash": 143.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANDIDA AMP PRB", "code_information": [{"code": "87481", "type": "CPT"}, {"code": "7258042", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "gross_charge": 646.0, "discounted_cash": 484.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANDIDA DIRECT PROBE", "code_information": [{"code": "87480", "type": "CPT"}, {"code": "4107486", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 102.27, "gross_charge": 530.0, "discounted_cash": 397.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 102.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANDIDA DNA QUANT", "code_information": [{"code": "87482", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 212.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 212.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANDIDA SPECIES PNL AMP PRB", "code_information": [{"code": "68U", "type": "CPT"}], "standard_charges": [{"minimum": 142.63, "maximum": 142.63, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANGRELOR PER 1MG IJ", "code_information": [{"code": "C9460", "type": "HCPCS"}, {"code": "5318855", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 20.55, "maximum": 22.83, "gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANGRELOR PER 1MG IJ", "code_information": [{"code": "C9460", "type": "HCPCS"}, {"code": "5318855", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 20.55, "maximum": 22.83, "gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNABINOID GC/MS QUANT", "code_information": [{"code": "80349", "type": "CPT"}, {"code": "7258316", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 1003.0, "discounted_cash": 752.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNABINOID SYNTHETIC 7/MORE", "code_information": [{"code": "80352", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS SYNTHETIC 1-3", "code_information": [{"code": "80350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS SYNTHETIC 4-6", "code_information": [{"code": "80351", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNULA DECLOTTING", "code_information": [{"code": "36861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAP NERVE AXOGUARD", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4020889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2215.5, "maximum": 2215.5, "gross_charge": 10550.0, "discounted_cash": 7912.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2215.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSAICIN 8% PATCH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7336", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.08, "maximum": 3.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARR CNV LOC MAP", "code_information": [{"code": "746T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARR N-INVAS LOC", "code_information": [{"code": "745T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARRHYT DLVR RAD", "code_information": [{"code": "747T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR ACOUS WAVFRM REC CAD RSK", "code_information": [{"code": "716T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNLPTHY GEN SEQ PNL", "code_information": [{"code": "237U", "type": "CPT"}], "standard_charges": [{"minimum": 584.9, "maximum": 584.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 10 GNS", "code_information": [{"code": "81413", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2987.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2987.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 2 GNS", "code_information": [{"code": "81414", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2987.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2987.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR SEAT/BED TEST 60MIN", "code_information": [{"code": "94780", "type": "CPT"}, {"code": "3114780", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "gross_charge": 670.0, "discounted_cash": 502.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR-CAR BP GRFT/ENDOVAS TAA", "code_information": [{"code": "33891", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1058.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1058.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1058.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1058.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1058.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR-T CLL ADMN AUTOLOGOUS", "code_information": [{"code": "540T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARBAMAZAPINE", "code_information": [{"code": "80156", "type": "CPT"}, {"code": "4102372", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.24, "gross_charge": 399.0, "discounted_cash": 299.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARBAMAZAPINE", "code_information": [{"code": "80156", "type": "CPT"}, {"code": "7252372", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.24, "gross_charge": 399.0, "discounted_cash": 299.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE", "code_information": [{"code": "80161", "type": "CPT"}, {"code": "7250094", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.64, "maximum": 18.64, "gross_charge": 129.0, "discounted_cash": 96.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE 100MG CTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301975", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE 100MG CTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301975", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE 100MG XRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301976", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE 100MG XRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301976", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301981", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301981", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE 400MG XRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301978", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE 400MG XRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301978", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE FREE", "code_information": [{"code": "80157", "type": "CPT"}, {"code": "7250157", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.6, "gross_charge": 136.0, "discounted_cash": 102.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.6, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE100/5 5MLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314482", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE100/5 5MLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314482", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBHYDRT DEFC TRNSFRRN", "code_information": [{"code": "82373", "type": "CPT"}, {"code": "7252373", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.09, "gross_charge": 265.0, "discounted_cash": 198.75, "setting": "both", 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"plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 77.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 77.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 77.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 77.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOASSIST EXTERNAL", "code_information": [{"code": "92971", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 231.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 106.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 208.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 202.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 231.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 231.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 231.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 106.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 106.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 106.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 106.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOASSIST INTERNAL", "code_information": [{"code": "92970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 182.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 393.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 382.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 437.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 437.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 437.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 182.63, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 182.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 182.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 182.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOKYMOGRAPHY", "code_information": [{"code": "Q0035", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLIPIN AB EA IG/2", "code_information": [{"code": "86147", "type": "CPT"}, {"code": "7256382", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 129.72, "gross_charge": 303.0, "discounted_cash": 227.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 129.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLIPIN AB EA IG/3", "code_information": [{"code": "86147", "type": "CPT"}, {"code": "7256385", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 129.72, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 129.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLIPIN AB EA IG/4", "code_information": [{"code": "86147", "type": "CPT"}, {"code": "7256386", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 129.72, "gross_charge": 146.0, "discounted_cash": 109.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 129.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLOGY HRT TRNSPL MRNA", "code_information": [{"code": "81595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10576.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10576.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3240.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLOGY SS", "code_information": [{"code": "G0063", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOPULM EXERCISE TESTING", "code_information": [{"code": "94621", "type": "CPT"}, {"code": "5504622", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 177.09, "maximum": 392.98, "gross_charge": 3523.0, "discounted_cash": 2642.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 177.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 177.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 177.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 177.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 177.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93015", "type": "CPT"}], "standard_charges": [{"minimum": 119.1, "maximum": 167.28, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 717.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 820.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 820.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 820.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 269.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 269.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 269.43, "methodology": "fee 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"plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 324.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 324.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE AFTER DELIVERY", "code_information": [{"code": "59430", "type": "CPT"}], "standard_charges": [{"minimum": 4200.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 20 MI", "code_information": [{"code": "G0081", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 30 M", "code_information": [{"code": "G0082", "type": 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"methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 60 M", "code_information": [{"code": "G0084", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MAN HOME CARE PLAN 60 M", "code_information": [{"code": "G0087", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 20 M", "code_information": [{"code": "G0076", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 30 M", "code_information": [{"code": "G0077", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 45 M", "code_information": [{"code": "G0078", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 60 M", "code_information": [{"code": "G0079", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 75 M", "code_information": [{"code": "G0080", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARE MANAGE BEH SVS 20MINS", "code_information": [{"code": "G0323", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.27, "maximum": 44.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 40.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 39.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 44.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 44.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 44.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE OF MISCARRIAGE", "code_information": [{"code": "59820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 34152.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE SURVEY NOT COMPLETE", "code_information": [{"code": "G0917", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAREGIVER HEALTH RISK ASSMT", "code_information": [{"code": "96161", "type": "CPT"}], "standard_charges": [{"minimum": 45.46, "maximum": 51.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 45.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER TRAING 1ST 30 MIN", "code_information": [{"code": "97550", "type": "CPT"}], "standard_charges": [{"minimum": 102.49, "maximum": 117.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 105.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 102.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 117.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 117.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 117.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER TRAING EA ADDL 15", "code_information": [{"code": "97551", "type": "CPT"}], "standard_charges": [{"minimum": 46.38, "maximum": 53.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 47.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 46.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 53.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 53.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 53.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARISOPRODOL 350MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302058", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CARISOPRODOL 350MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302058", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CARMUSTINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9050", "type": "HCPCS"}], "standard_charges": [{"minimum": 214.61, "maximum": 238.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 214.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 238.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 238.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 238.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 238.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARNITINE", "code_information": [{"code": "82379", "type": "CPT"}, {"code": "7252379", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 86.03, "gross_charge": 167.0, "discounted_cash": 125.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 86.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAROTENE", "code_information": [{"code": "82380", "type": "CPT"}, {"code": "7252380", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 47.05, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 47.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.89, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [{"code": "35", "type": "MS-DRG"}], "standard_charges": [{"minimum": 79369.38, "maximum": 100016.13, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 79369.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 100016.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [{"code": "34", "type": "MS-DRG"}], "standard_charges": [{"minimum": 128514.98, "maximum": 161946.22, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 128514.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 161946.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "36", "type": "MS-DRG"}], "standard_charges": [{"minimum": 64504.85, "maximum": 81284.81, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64504.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 81284.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARPAL TUNNEL SURGERY", "code_information": [{"code": "64721", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 23172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARVEDILOL 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302079", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CARVEDILOL 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302079", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CARVEDILOL 3.125MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302077", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CARVEDILOL 3.125MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302077", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CASE MANAGEMENT", "code_information": [{"code": "T1016", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASE MANAGEMENT, PER MONTH", "code_information": [{"code": "T2022", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAST SUPPLIES (PLASTER)", "code_information": [{"code": "A4580", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAST SUPPLIES UNLISTED", "code_information": [{"code": "Q4050", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATARACT SURG W/IOL 1 STAGE", "code_information": [{"code": "66983", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14311.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12878.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14311.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATECHOLAMINES FRAC", "code_information": [{"code": "82384", "type": "CPT"}, {"code": "7252384", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 128.77, "gross_charge": 604.0, "discounted_cash": 453.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 128.77, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATECHOLAMINES FRAC/2", "code_information": [{"code": "82384", "type": "CPT"}, {"code": "7252385", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 128.77, "gross_charge": 347.0, "discounted_cash": 260.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 128.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATECHOLAMINES FRAC/3", "code_information": [{"code": "82384", "type": "CPT"}, {"code": "7252386", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 128.77, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 128.77, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABL BI-DIR IRRIGATD", "code_information": [{"code": "C2630", "type": "HCPCS"}, {"code": "8055015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 995.82, "maximum": 995.82, "gross_charge": 4742.0, "discounted_cash": 3556.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 995.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABL BIDRCT THRMCOOL", "code_information": [{"code": "C1732", "type": "HCPCS"}, {"code": "8055003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1614.48, "maximum": 1614.48, "gross_charge": 7688.0, "discounted_cash": 5766.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1614.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABL BLAZER II 7", "code_information": [{"code": "C1733", "type": "HCPCS"}, {"code": "8245000", "type": "CDM"}], "standard_charges": [{"minimum": 1769.88, "maximum": 1769.88, "gross_charge": 8428.0, "discounted_cash": 6321.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1769.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABL ESOP BLN 360D", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "4031201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1279.74, "maximum": 1279.74, "gross_charge": 6094.0, "discounted_cash": 4570.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABL ESOP HALO90D", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "8056047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1279.74, "maximum": 1279.74, "gross_charge": 6094.0, "discounted_cash": 4570.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABL NAVISTR DEFL TI", "code_information": [{"code": "C1732", "type": "HCPCS"}, {"code": "8240645", "type": "CDM"}], "standard_charges": [{"minimum": 5116.86, "maximum": 5116.86, "gross_charge": 24366.0, "discounted_cash": 18274.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 5116.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABL NONCARD ENDO", "code_information": [{"code": "C1888", "type": "HCPCS"}, {"code": "8240073", "type": "CDM"}], "standard_charges": [{"minimum": 2904.3, "maximum": 2904.3, "gross_charge": 13830.0, "discounted_cash": 10372.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABL RF CONDUCTR MC", "code_information": [{"code": "C1733", "type": "HCPCS"}, {"code": "8240100", "type": "CDM"}], "standard_charges": [{"minimum": 1769.88, "maximum": 1769.88, "gross_charge": 8428.0, "discounted_cash": 6321.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1769.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABL RF ENDOVENOUS", "code_information": [{"code": "C1888", "type": "HCPCS"}, {"code": "8055010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 633.78, "maximum": 633.78, "gross_charge": 3018.0, "discounted_cash": 2263.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 633.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABL SAFIRE", "code_information": [{"code": "C1733", "type": "HCPCS"}, {"code": "8240028", "type": "CDM"}], "standard_charges": [{"minimum": 5704.23, "maximum": 5704.23, "gross_charge": 27163.0, "discounted_cash": 20372.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 5704.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABLATION INTELLANAV ST", "code_information": [{"code": "C1733", "type": "HCPCS"}, {"code": "8055019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4369.89, "maximum": 4369.89, "gross_charge": 20809.0, "discounted_cash": 15606.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4369.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABLATN 3D MAPPNG", "code_information": [{"code": "C1732", "type": "HCPCS"}, {"code": "8056146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5116.86, "maximum": 5116.86, "gross_charge": 24366.0, "discounted_cash": 18274.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 5116.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ACCESS DUAL LUMEN", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8056003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 34.86, "maximum": 34.86, "gross_charge": 166.0, "discounted_cash": 124.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 34.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ANG FLUSH ACCU-VU", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "8055008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 137.76, "maximum": 137.76, "gross_charge": 656.0, "discounted_cash": 492.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 137.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ANG QUICK-CROSS", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "8240029", "type": "CDM"}], "standard_charges": [{"minimum": 1581.72, "maximum": 1581.72, "gross_charge": 7532.0, "discounted_cash": 5649.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1581.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ANG TRANSLUM NLSR2", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 397.74, "maximum": 397.74, "gross_charge": 1894.0, "discounted_cash": 1420.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 397.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ANG TRANSLUM NLSR3", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 121.59, "maximum": 121.59, "gross_charge": 579.0, "discounted_cash": 434.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ANG TRANSLUM NLSR4", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240141", "type": "CDM"}], "standard_charges": [{"minimum": 14.7, "maximum": 14.7, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ANG TRANSLUMNL NLSR", "code_information": [{"code": 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CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 752.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH L VENTRICAL/ATRIAL", "code_information": [{"code": "93565", "type": "CPT"}, {"code": "4613566", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1938.0, "gross_charge": 2040.0, "discounted_cash": 1530.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 1938.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 752.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH LT HRT W/LTVENT", "code_information": [{"code": "93452", "type": "CPT"}, {"code": "4613452", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 18713.1, "gross_charge": 19698.0, "discounted_cash": 14773.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4136.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 18713.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3940.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3827.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4377.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4377.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4377.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 18713.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7268.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 14773.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 14773.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3940.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3827.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4377.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4377.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4377.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 18713.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7268.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 14773.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 14773.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH LT HRT/TRSEPTPUNCT", "code_information": [{"code": "93462", "type": "CPT"}, {"code": "4613463", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16802.65, "gross_charge": 17687.0, "discounted_cash": 13265.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3714.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 16802.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 16802.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6526.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 13265.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 13265.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH LT HRT/TRSEPTPUNCT", "code_information": [{"code": "93462", "type": "CPT"}, {"code": "4613463", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16802.65, "gross_charge": 17687.0, "discounted_cash": 13265.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3714.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH MAPPING ACHIEVE ADVANCE", "code_information": [{"code": "C1730", "type": "HCPCS"}, {"code": "8056586", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1204.98, "maximum": 1204.98, "gross_charge": 5738.0, "discounted_cash": 4303.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1204.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH MICRO-DILATATION MR", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056583", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 467.67, "maximum": 467.67, "gross_charge": 2227.0, "discounted_cash": 1670.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 467.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH NEPHROSTOMY", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8056615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.95, "maximum": 271.95, "gross_charge": 1295.0, "discounted_cash": 971.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 271.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH OCCLUSION", "code_information": [{"code": "C2628", "type": "HCPCS"}, {"code": "8240115", "type": "CDM"}], "standard_charges": [{"minimum": 83.37, "maximum": 83.37, "gross_charge": 397.0, "discounted_cash": 297.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 83.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH P-DIAL SAPHIRE", "code_information": [{"code": "C1750", "type": "HCPCS"}, {"code": "4031481", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 511.98, "maximum": 511.98, "gross_charge": 2438.0, "discounted_cash": 1828.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 511.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PACE MAP BOSTN SCI", "code_information": [{"code": "C1730", "type": "HCPCS"}, {"code": "8245840", "type": "CDM"}], "standard_charges": [{"minimum": 120.33, "maximum": 120.33, "gross_charge": 573.0, "discounted_cash": 429.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 120.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PERI IMGNG OPTICROSS", "code_information": [{"code": "C1753", "type": "HCPCS"}, {"code": "8058056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1056.09, "maximum": 1056.09, "gross_charge": 5029.0, "discounted_cash": 3771.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1056.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PERIPHERAL SUPPORT", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "8056646", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 416.01, "maximum": 416.01, "gross_charge": 1981.0, "discounted_cash": 1485.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 416.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PERIPHL CTO CROSSER", "code_information": [{"code": "C1714", "type": "HCPCS"}, {"code": "4031482", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2470.23, "maximum": 2470.23, "gross_charge": 11763.0, "discounted_cash": 8822.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2470.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PERIT DIAL LNG TRM", "code_information": [{"code": "C1750", "type": "HCPCS"}, {"code": "4031483", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 96.39, "maximum": 96.39, "gross_charge": 459.0, "discounted_cash": 344.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 96.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PIGTAIL MERIT AD/PD", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8245960", "type": "CDM"}], "standard_charges": [{"minimum": 41.37, "maximum": 41.37, "gross_charge": 197.0, "discounted_cash": 147.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 41.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PLACE CARDIO BRACHYTX", "code_information": [{"code": "92974", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 173.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 173.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 173.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 173.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 173.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH PRPH DIL RX VTRC 14", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240090", "type": "CDM"}], "standard_charges": [{"minimum": 242.34, "maximum": 242.34, "gross_charge": 1154.0, "discounted_cash": 865.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 242.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA ADMIRAL XTREME", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "4031335", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 189.63, "maximum": 189.63, "gross_charge": 903.0, "discounted_cash": 677.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 189.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA ADVANC35LP BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056669", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 641.55, "maximum": 641.55, "gross_charge": 3055.0, "discounted_cash": 2291.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 641.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA AMPHIRION DEEP", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8245964", "type": "CDM"}], "standard_charges": [{"minimum": 521.22, "maximum": 521.22, "gross_charge": 2482.0, "discounted_cash": 1861.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 521.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA ANGIOSCULPT", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "4031495", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1619.31, "maximum": 1619.31, "gross_charge": 7711.0, "discounted_cash": 5783.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1619.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA BLN ADVNC MICRO14 ULP", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056898", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 652.89, "maximum": 652.89, "gross_charge": 3109.0, "discounted_cash": 2331.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 652.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA BLN CORDIS OPTA", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240047", "type": "CDM"}], "standard_charges": [{"minimum": 244.23, "maximum": 244.23, "gross_charge": 1163.0, "discounted_cash": 872.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 244.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA BLN FF ULTRASCORE", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056882", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1920.24, "maximum": 1920.24, "gross_charge": 9144.0, "discounted_cash": 6858.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1920.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA BLN PWRFLX", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240051", "type": "CDM"}], "standard_charges": [{"minimum": 26.88, "maximum": 26.88, "gross_charge": 128.0, "discounted_cash": 96.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 26.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA BLN ULTRA LOW PROFILE", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 519.12, "maximum": 519.12, "gross_charge": 2472.0, "discounted_cash": 1854.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 519.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA CORDIS MAXI LD", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240046", "type": "CDM"}], "standard_charges": [{"minimum": 321.3, "maximum": 321.3, "gross_charge": 1530.0, "discounted_cash": 1147.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA CORDIS OPTA LP", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240048", "type": "CDM"}], "standard_charges": [{"minimum": 204.54, "maximum": 204.54, "gross_charge": 974.0, "discounted_cash": 730.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 204.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA DIL ATLAS GOLD", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8058259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 406.77, "maximum": 406.77, "gross_charge": 1937.0, "discounted_cash": 1452.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 406.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA DIL CONQUEST", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240059", "type": "CDM"}], "standard_charges": [{"minimum": 248.43, "maximum": 248.43, "gross_charge": 1183.0, "discounted_cash": 887.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 248.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA DIL CRDIS SAVVY", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240837", "type": "CDM"}], "standard_charges": [{"minimum": 416.01, "maximum": 416.01, "gross_charge": 1981.0, "discounted_cash": 1485.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 416.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA DIL ULTRAVERSE", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8245961", "type": "CDM"}], "standard_charges": [{"minimum": 248.43, "maximum": 248.43, "gross_charge": 1183.0, "discounted_cash": 887.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 248.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA EVERCROSS BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 226.17, "maximum": 226.17, "gross_charge": 1077.0, "discounted_cash": 807.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 226.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA FOX PLUS", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "4031494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 257.46, "maximum": 257.46, "gross_charge": 1226.0, "discounted_cash": 919.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 257.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA NANOCRS ELT OTW", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056887", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 450.24, "maximum": 450.24, "gross_charge": 2144.0, "discounted_cash": 1608.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 450.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA OPTIPLAST XT5", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8245967", "type": "CDM"}], "standard_charges": [{"minimum": 213.36, "maximum": 213.36, "gross_charge": 1016.0, "discounted_cash": 762.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 213.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA PACIFC PLUS BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8058261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 283.29, "maximum": 283.29, "gross_charge": 1349.0, "discounted_cash": 1011.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 283.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA SLEEK DIL OTW", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056678", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1619.31, "maximum": 1619.31, "gross_charge": 7711.0, "discounted_cash": 5783.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1619.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA SLEEK RX DILTAT", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8058257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 275.1, "maximum": 275.1, "gross_charge": 1310.0, "discounted_cash": 982.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 275.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA SUBMARINE+ OTW", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8245968", "type": "CDM"}], "standard_charges": [{"minimum": 283.29, "maximum": 283.29, "gross_charge": 1349.0, "discounted_cash": 1011.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 283.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA SV FOX", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8245969", "type": "CDM"}], "standard_charges": [{"minimum": 559.02, "maximum": 559.02, "gross_charge": 2662.0, "discounted_cash": 1996.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 559.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTA VASCUTRAK BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056673", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 828.66, "maximum": 828.66, "gross_charge": 3946.0, "discounted_cash": 2959.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 828.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTCA APEX OTW BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1152.27, "maximum": 1152.27, "gross_charge": 5487.0, "discounted_cash": 4115.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1152.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTCA APEX RX BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056667", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 150.57, "maximum": 150.57, "gross_charge": 717.0, "discounted_cash": 537.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 150.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTCA BLN MR EMERGE", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056649", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 150.57, "maximum": 150.57, "gross_charge": 717.0, "discounted_cash": 537.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 150.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTCA EMERGE MR US BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 119.7, "maximum": 119.7, "gross_charge": 570.0, "discounted_cash": 427.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTCA MAVERCK MONORL", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240845", "type": "CDM"}], "standard_charges": [{"minimum": 150.57, "maximum": 150.57, "gross_charge": 717.0, "discounted_cash": 537.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 150.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PTCA SCORING RX BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056892", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1619.31, "maximum": 1619.31, "gross_charge": 7711.0, "discounted_cash": 5783.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1619.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PWR PICC SOLO DL", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "4031501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 410.55, "maximum": 410.55, "gross_charge": 1955.0, "discounted_cash": 1466.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 410.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PWR PICC SOLO SL", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "4031502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 277.62, "maximum": 277.62, "gross_charge": 1322.0, "discounted_cash": 991.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 277.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH PWR PICC SOLO TL", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "4031503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 200.13, "maximum": 200.13, "gross_charge": 953.0, "discounted_cash": 714.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 200.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH QUANTUM MAVERICK", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056682", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 93.45, "maximum": 93.45, "gross_charge": 445.0, "discounted_cash": 333.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 93.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH R HRT ART/GRFT ANGI", "code_information": [{"code": "93457", "type": "CPT"}, {"code": "4613457", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "gross_charge": 13811.0, "discounted_cash": 10358.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2900.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 13120.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3940.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3827.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4377.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4377.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4377.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", 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"billing_class": "facility"}]}, {"description": "CATH, BRACHYTX SEED ADM", "code_information": [{"code": "C1728", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, PACING, TRANSESOPH", "code_information": [{"code": "C1756", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, TRANS ATHEREC,ROTATION", "code_information": [{"code": "C1724", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH, TRANSLUMIN ANGIO LASER", "code_information": [{"code": "C1885", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/EMBOL", "code_information": [{"code": "C7515", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/STENTS", "code_information": [{"code": "C7514", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIALCIR W/APLASTY", "code_information": [{"code": "C7513", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH/APLASTY DIAL CIR W/STNT", "code_information": [{"code": "C7530", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATHETER FOR HYSTEROGRAPHY", "code_information": [{"code": "58340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1426.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 155.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 155.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 155.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 155.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 155.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATHETER IVUS", "code_information": [{"code": "C1753", "type": "HCPCS"}, {"code": "8056542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1129.8, "maximum": 1129.8, "gross_charge": 5380.0, "discounted_cash": 4035.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1129.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER, ABLATION", "code_information": [{"code": "C1886", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETER, INTRADISCAL", "code_information": [{"code": "C1754", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETERIZE FOR URINE SPEC", "code_information": [{"code": "P9612", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAUTERIZATION OF CERVIX", "code_information": [{"code": "57510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17320.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 52.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 52.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 52.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 52.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 52.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAVOPULMONARY SHUNTING", "code_information": [{"code": "33768", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 412.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 412.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 412.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 412.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 412.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CBC AUTO W/O DIFF", "code_information": [{"code": "85027", "type": "CPT"}, {"code": "4100056", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.0, "gross_charge": 165.0, "discounted_cash": 123.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC WITH AUTO DIFF", "code_information": [{"code": "85025", "type": "CPT"}, {"code": "4105028", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 39.64, "gross_charge": 187.0, "discounted_cash": 140.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 39.64, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC WITHOUT PLATELET", "code_information": [{"code": "G0307", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC/DIFFWBC W/O PLATELET", "code_information": [{"code": "G0306", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 39.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 39.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBL ORTHO W CRIMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 599.34, "maximum": 599.34, "gross_charge": 2854.0, "discounted_cash": 2140.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 599.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBLE FIX BN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 623.49, "maximum": 623.49, "gross_charge": 2969.0, "discounted_cash": 2226.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 623.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBLE FIX BN SLEVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 410.13, "maximum": 410.13, "gross_charge": 1953.0, "discounted_cash": 1464.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 410.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CCHD", "code_information": [{"code": "94760", "type": "CPT"}, {"code": "3110670", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 2.9, "maximum": 2.9, "gross_charge": 512.0, "discounted_cash": 384.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CCIIV4 VACC ABX FREE IM", "code_information": [{"code": "90756", "type": "CPT"}], "standard_charges": [{"minimum": 30.67, "maximum": 34.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 34.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CCM/BHI BY RHC/FQHC 20MIN MO", "code_information": [{"code": "G0511", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.77, "maximum": 75.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 67.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 65.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 75.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 75.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 75.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CCND1/IGH TRANSLOCATION ALYS", "code_information": [{"code": "81168", "type": "CPT"}], "standard_charges": [{"minimum": 207.31, "maximum": 207.31, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CDP-SOT 6 COND W/I&R", "code_information": [{"code": "92548", "type": "CPT"}], "standard_charges": [{"minimum": 112.7, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CDSM CURBSIDE", "code_information": [{"code": "G1020", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CDTB&VINCULIN IGG ANTB IA", "code_information": [{"code": "176U", "type": "CPT"}], "standard_charges": [{"minimum": 64.19, "maximum": 64.19, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 64.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEBPA GENE FULL SEQUENCE", "code_information": [{"code": "81218", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1235.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1235.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 241.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 241.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFIXIME100/5 50ML PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314559", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 198.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEFIXIME100/5 50ML PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314559", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 198.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEFTAROLINE PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0712", "type": "HCPCS"}, {"code": "5319052", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.81, "maximum": 4.23, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFTAROLINE PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0712", "type": "HCPCS"}, {"code": "5319052", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.81, "maximum": 4.23, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFTAZIDIME AND AVIBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0714", "type": "HCPCS"}], "standard_charges": [{"minimum": 94.26, "maximum": 104.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 94.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 104.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 104.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 104.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 104.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFTIZOXIME SODIUM / 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0715", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.72, "maximum": 5.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH 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{"description": "CEMT BN PL FUL BIOMT CAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 332.85, "maximum": 332.85, "gross_charge": 1585.0, "discounted_cash": 1188.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 332.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMT BN PL HF BIOMET CAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011885", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 69.09, "maximum": 69.09, "gross_charge": 329.0, "discounted_cash": 246.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 69.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMT BN W/ANTIBIOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 391.65, "maximum": 391.65, "gross_charge": 1865.0, "discounted_cash": 1398.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 391.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMT BON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8173505", "type": "CDM"}], "standard_charges": [{"minimum": 320.88, "maximum": 320.88, "gross_charge": 1528.0, "discounted_cash": 1146.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 320.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMT PLUG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 82.95, "maximum": 82.95, "gross_charge": 395.0, "discounted_cash": 296.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 82.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMT RSTR SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8173565", "type": "CDM"}], "standard_charges": [{"minimum": 134.19, "maximum": 134.19, "gross_charge": 639.0, "discounted_cash": 479.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 134.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CENTERBASED DAY CARE PERDIEM", "code_information": [{"code": "S5105", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CENTRUROIDES IMMUNE F(AB)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0716", "type": "HCPCS"}], "standard_charges": [{"minimum": 5382.5, "maximum": 5980.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5382.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5980.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5980.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5980.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5980.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEP72 NUDT15&TPMT GENE ALYS", "code_information": [{"code": "286U", "type": "CPT"}], "standard_charges": [{"minimum": 134.13, "maximum": 134.13, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHALEXIN 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302204", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CEPHALEXIN 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302204", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CEPHALEXIN 500MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302208", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CEPHALEXIN 500MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302208", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CEPHALEXIN125/5 100 PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314564", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CEPHALEXIN125/5 100 PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314564", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CEPHALEXIN250/5 100 PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314568", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CEPHALEXIN250/5 100 PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314568", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CEPHALIN FLOCULATION TEST", "code_information": [{"code": "P2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.95, "maximum": 4.95, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHAPIRIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0710", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.4, "maximum": 1.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERT NURSE MIDWIFE SS", "code_information": [{"code": "G0064", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CERTOLIZUMAB PEGOL INJ 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0717", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.52, "maximum": 3.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERULOPLASMIN", "code_information": [{"code": "82390", "type": "CPT"}, {"code": "7252390", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.79, "gross_charge": 180.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 54.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL LAMINOPLSTY 2/> SEG", "code_information": [{"code": "63050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1431.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1431.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1431.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1431.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1431.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERVICAL MYELO LUMB INJ", "code_information": [{"code": "4902301", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5519.0, "discounted_cash": 4139.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL MYELO LUMB INJ", "code_information": [{"code": "4912301", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3310.0, "discounted_cash": 2482.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [{"code": "472", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 123261.88, "estimated_discounted_cash": 197352.74, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 97816.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 123261.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [{"code": "471", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 202027.98, "estimated_discounted_cash": 194849.09, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 160322.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 202027.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITHOUT CC/MCC", "code_information": [{"code": "473", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 102141.55, "estimated_discounted_cash": 435098.1, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 81056.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 102141.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN BIRTH CLASS", "code_information": [{"code": "S9438", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY", "code_information": [{"code": "59510", "type": "CPT"}], "standard_charges": [{"minimum": 1988.69, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1988.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1988.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1988.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1988.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1988.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY", "code_information": [{"code": "59515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1068.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1068.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1068.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1068.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1068.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY ONLY", "code_information": [{"code": "59514", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [{"code": "784", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9042.0, "maximum": 44353.52, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 9042.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14653.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35197.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44353.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [{"code": "783", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9042.0, "maximum": 102718.93, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 9042.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14653.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 81514.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 102718.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "785", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9042.0, "maximum": 40073.39, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 9042.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14653.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31800.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40073.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [{"code": "787", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9042.0, "maximum": 46725.8, "estimated_discounted_cash": 44101.48, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 9042.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14653.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37079.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46725.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [{"code": "786", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9042.0, "maximum": 69013.43, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 9042.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14653.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 54766.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 69013.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "788", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9042.0, "maximum": 40115.23, "estimated_discounted_cash": 37212.89, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 9042.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14653.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31834.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40115.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESSJ THERAPY CATH REMOVAL", "code_information": [{"code": "37214", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CETIRIZINE 1MG/ML 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314594", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CETIRIZINE 1MG/ML 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314594", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CETIRIZINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302245", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CETIRIZINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302245", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CETUXIMAB PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9055", "type": "HCPCS"}, {"code": "5319201", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 70.53, "maximum": 78.37, "gross_charge": 360.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 70.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CETUXIMAB PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9055", "type": "HCPCS"}, {"code": "5319201", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 70.53, "maximum": 78.37, "gross_charge": 360.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 70.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR COMMON VARIANTS", "code_information": [{"code": "81220", "type": "CPT"}, {"code": "7251241", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 556.6, "maximum": 556.6, "gross_charge": 11462.0, "discounted_cash": 8596.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 556.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 556.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR FULL GEN SEQ", "code_information": [{"code": "81223", "type": "CPT"}, {"code": "7011223", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 499.0, "maximum": 499.0, "gross_charge": 7065.0, "discounted_cash": 5298.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 499.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 499.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE DUP/DELET VARIANTS", "code_information": [{"code": "81222", "type": "CPT"}], "standard_charges": [{"minimum": 435.07, "maximum": 435.07, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 435.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 435.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE INTRON POLY T", "code_information": [{"code": "81224", "type": "CPT"}], "standard_charges": [{"minimum": 168.75, "maximum": 168.75, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81221", "type": "CPT"}], "standard_charges": [{"minimum": 97.22, "maximum": 97.22, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 97.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 97.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CGH TEST DEVELOPMENTAL DELAY", "code_information": [{"code": "S3870", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CH GTUBE TO GJTUBE W/FLU", "code_information": [{"code": "4919446", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8127.0, "discounted_cash": 6095.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE BILIARY DRAIN CTH", "code_information": [{"code": "4917515", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19022.0, "discounted_cash": 14266.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE CYSTO TB SMPL", "code_information": [{"code": "4912040", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1007.0, "discounted_cash": 755.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE CYSTO TUBE COMPLT", "code_information": [{"code": "4912042", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4597.0, "discounted_cash": 3447.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE G-TUBE TO G-J PERC", "code_information": [{"code": "49446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE GASTRIC PORT OPEN", "code_information": [{"code": "43888", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 26018.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE NEPHROSTOMY TUBE", "code_information": [{"code": "4917520", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5166.0, "discounted_cash": 3874.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE NEPHROURETERAL CATH", "code_information": [{"code": "50387", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF BLADDER TUBE", "code_information": [{"code": "51705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF BLADDER TUBE", "code_information": [{"code": "51710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF URETER TUBE/STENT", "code_information": [{"code": "50688", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF WINDPIPE AIRWAY", "code_information": [{"code": "31502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2967.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 59.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 59.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 59.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 59.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 59.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE PERC DRAIN CATH", "code_information": [{"code": "75984", "type": "CPT"}, {"code": "4915985", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 332.01, "gross_charge": 1581.0, "discounted_cash": 1185.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 332.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 258.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 131.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 131.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 131.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 131.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 131.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE PERC DRAIN CATH", "code_information": [{"code": "75984", "type": "CPT"}, {"code": "5055984", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 332.01, "gross_charge": 1581.0, "discounted_cash": 1185.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 332.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 258.41, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 131.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 131.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 131.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 131.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 131.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE STENT VIA TRANSURETH", "code_information": [{"code": "50385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE URETER STENT PERC", "code_information": [{"code": "4917526", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16483.0, "discounted_cash": 12362.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE URETER STENT PERCUT", "code_information": [{"code": "50382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE URETEROSTOMY TUBE", "code_information": [{"code": "4917525", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5007.0, "discounted_cash": 3755.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CHCT FOR MAL HYPERTHERMIA", "code_information": [{"code": "89049", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 218.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 218.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEM CAUT OF GRANLTJ TISSUE", "code_information": [{"code": "17250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1264.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEM CAUTERY OF TISSUE", "code_information": [{"code": "6904010", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CHEM CAUTERY OF TISSUE", "code_information": [{"code": "6904010", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL FACE DERMAL", "code_information": [{"code": "15789", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL FACE EPIDERM", "code_information": [{"code": "15788", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15792", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15793", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMILUMINESCENT ASY/2", "code_information": [{"code": "82397", "type": "CPT"}, {"code": "7252397", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.05, "gross_charge": 304.0, "discounted_cash": 228.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 72.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMILUMINESCENT ASY/3", "code_information": [{"code": "82397", "type": "CPT"}, {"code": "7252398", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.05, "gross_charge": 304.0, "discounted_cash": 228.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 72.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMILUMINESCENT ASY/4", "code_information": [{"code": "82397", "type": "CPT"}, {"code": "7252402", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.05, "gross_charge": 304.0, "discounted_cash": 228.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 72.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMILUMINESCENT ASY/6", "code_information": [{"code": "82397", "type": "CPT"}, {"code": "7253558", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.05, "gross_charge": 304.0, "discounted_cash": 228.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 72.05, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMILUMNESCENT ASY", "code_information": [{"code": "82397", "type": "CPT"}, {"code": "7252396", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.05, "gross_charge": 347.0, "discounted_cash": 260.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 72.05, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO ADM CNS", "code_information": [{"code": "96450", "type": "CPT"}, {"code": "4916450", "type": "CDM"}, {"code": "331", "type": "RC"}], "standard_charges": [{"minimum": 329.72, "maximum": 449.16, "gross_charge": 2771.0, "discounted_cash": 2078.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 329.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 404.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 392.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 329.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 329.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 329.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 329.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO ADM CNS", "code_information": [{"code": "96450", "type": "CPT"}, {"code": "6296450", "type": "CDM"}, {"code": "331", "type": "RC"}], "standard_charges": [{"minimum": 329.72, "maximum": 449.16, "gross_charge": 2995.0, "discounted_cash": 2246.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 329.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 404.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 392.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 449.16, 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CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 207.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 207.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 207.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 207.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 207.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV <=1H INIT", "code_information": [{"code": "96413", "type": "CPT"}, {"code": "4546413", "type": "CDM"}, {"code": "335", "type": "RC"}], "standard_charges": [{"minimum": 191.93, "maximum": 449.16, "gross_charge": 2335.0, "discounted_cash": 1751.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 191.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 404.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 392.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 191.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 191.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 191.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 191.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV <=1H INIT", "code_information": [{"code": "96413", "type": "CPT"}, {"code": "6926413", "type": "CDM"}, {"code": "335", "type": "RC"}], "standard_charges": [{"minimum": 191.93, "maximum": 449.16, "gross_charge": 1753.0, "discounted_cash": 1314.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 191.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 404.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 392.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 191.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 191.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 191.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 191.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO SQ/IM HORMONAL", "code_information": [{"code": "96402", "type": "CPT"}, {"code": "6926402", "type": "CDM"}, {"code": "331", "type": "RC"}], "standard_charges": [{"minimum": 47.75, "maximum": 93.07, "gross_charge": 291.0, "discounted_cash": 218.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 47.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 47.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 47.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 47.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 47.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO SQ/IM NONHORMONAL", "code_information": [{"code": "96401", "type": "CPT"}, {"code": "6926401", "type": "CDM"}, {"code": "331", "type": "RC"}], "standard_charges": [{"minimum": 76.97, "maximum": 93.07, "gross_charge": 710.0, "discounted_cash": 532.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 76.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 76.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 76.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 76.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 76.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENER MUSCLE LARYNX EMG", "code_information": [{"code": "64617", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 1-4 EA", "code_information": [{"code": "64643", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 5/> EA", "code_information": [{"code": "64645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 5/> MUS", "code_information": [{"code": "64644", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREMITY 1-4", "code_information": [{"code": "64642", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ADDUCT VOCAL", "code_information": [{"code": "S2341", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64653", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC MIGRAINE", "code_information": [{"code": "64615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC NECK DYSTON", "code_information": [{"code": "64616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV SALIV GLANDS", "code_information": [{"code": "64611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV TRUNK MUSC 1-5", "code_information": [{"code": "64646", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15369.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV TRUNK MUSC 6/>", "code_information": [{"code": "64647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION ANAL MUSC", "code_information": [{"code": "46505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF ABDUCTOR", "code_information": [{"code": "S2340", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTAXIS ASSAY", "code_information": [{"code": "86155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 81.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 81.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY BY INFUSION", "code_information": [{"code": "Q0084", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INFUSION METHOD", "code_information": [{"code": "96425", "type": "CPT"}], "standard_charges": [{"minimum": 218.55, "maximum": 449.16, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 218.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 404.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 392.77, "methodology": "fee 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"UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 69305.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 87334.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "839", "type": "MS-DRG"}], "standard_charges": [{"minimum": 47940.37, "maximum": 60411.33, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47940.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 60411.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [{"code": "847", "type": "MS-DRG"}], "standard_charges": [{"minimum": 43434.86, "maximum": 54733.78, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43434.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 54733.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [{"code": "846", "type": "MS-DRG"}], "standard_charges": [{"minimum": 86076.18, "maximum": 108467.61, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 86076.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108467.61, "methodology": "case rate"}], "billing_class": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEST 2 VIEWS", "code_information": [{"code": "71046", "type": "CPT"}, {"code": "4901046", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 80.9, "gross_charge": 1053.0, "discounted_cash": 789.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED 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"standard_charge_dollar": 260.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 260.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIROPRACT MANJ 1-2 REGIONS", "code_information": [{"code": "98940", "type": "CPT"}], "standard_charges": [{"minimum": 33.75, "maximum": 38.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIROPRACT MANJ XTRSPINL 1/>", "code_information": [{"code": "98943", "type": "CPT"}], "standard_charges": [{"minimum": 42.01, "maximum": 48.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 43.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 42.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 48.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIROPRACTIC MANJ 5 REGIONS", "code_information": [{"code": "98942", "type": "CPT"}], "standard_charges": [{"minimum": 33.75, "maximum": 38.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIROPRACTIC SS", "code_information": [{"code": "G0065", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA AB", "code_information": [{"code": "86631", "type": "CPT"}, {"code": "7256631", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 60.3, "gross_charge": 69.0, "discounted_cash": 51.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 60.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA AMP PROBE", "code_information": [{"code": "87491", "type": "CPT"}, {"code": "4107492", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "gross_charge": 646.0, "discounted_cash": 484.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLINESTERASE RBC", "code_information": [{"code": "82482", "type": "CPT"}, {"code": "7252482", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 39.2, "gross_charge": 150.0, "discounted_cash": 112.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 39.2, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHORE SERVICES PER 15 MIN", "code_information": [{"code": "S5120", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHORE SERVICES PER DIEM", "code_information": [{"code": "S5121", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHORION BIOPSY", "code_information": [{"code": "59015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRISTIAN SCI PRACT VISIT", "code_information": [{"code": "S9900", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHRM ANAL 15-20 CELL W/BND", "code_information": [{"code": "88262", "type": "CPT"}, {"code": "7258256", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 635.61, "gross_charge": 1651.0, "discounted_cash": 1238.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 635.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 174.14, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 174.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 174.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 174.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 174.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 125.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 125.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRM ANAL AMNIOTIC/VILL", "code_information": [{"code": "88267", "type": "CPT"}, {"code": "7258827", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 916.77, "gross_charge": 3826.0, "discounted_cash": 2869.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 916.77, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 251.17, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 251.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 251.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 251.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 251.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 188.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 188.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROM/MASS SPEC NES QL", "code_information": [{"code": "82542", "type": "CPT"}, {"code": "7251420", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.09, "gross_charge": 417.0, "discounted_cash": 312.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROM/MASS SPEC NES QL/22", "code_information": [{"code": "82542", "type": "CPT"}, {"code": "7255428", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.09, "gross_charge": 384.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROM/MASS SPEC NES QL/28", "code_information": [{"code": "82542", "type": "CPT"}, {"code": "7258333", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.09, "gross_charge": 384.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROM/MASS SPEC NES QL/8", "code_information": [{"code": "82542", "type": "CPT"}, {"code": "7252521", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.09, "gross_charge": 770.0, "discounted_cash": 577.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMATOGRAM ASSAY SUGARS", "code_information": [{"code": "84375", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 99.97, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMIUM/2", "code_information": [{"code": "82495", "type": "CPT"}, {"code": "7252495", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 103.44, "gross_charge": 244.0, "discounted_cash": 183.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 103.44, 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"billing_class": "facility"}]}, {"description": "CINE/VIDEO X-RAYS", "code_information": [{"code": "76120", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 159.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 159.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 85.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 85.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 85.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 85.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 85.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CINE/VIDEO X-RAYS ADD-ON", "code_information": [{"code": "76125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302775", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302775", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN 500MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302776", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN 500MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302776", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCAID COMP STOCKNG", "code_information": [{"code": "L2999", "type": "HCPCS"}, {"code": "8130137", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "286", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 92581.34, "estimated_discounted_cash": 117583.91, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 73469.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 92581.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [{"code": "287", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 44771.91, "estimated_discounted_cash": 54974.15, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35529.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44771.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCUM 28 DAYS OR OLDER", "code_information": [{"code": "54161", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 23671.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION", "code_information": [{"code": "3110150", "type": "CDM"}, {"code": "723", "type": "RC"}], "standard_charges": [{"gross_charge": 3683.0, "discounted_cash": 2762.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUMCISION NEONATE", "code_information": [{"code": "54160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3683.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION W/REGIONL BLOCK", "code_information": [{"code": "54150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 24302.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [{"code": "433", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35067.95, "maximum": 44190.35, "estimated_discounted_cash": 57285.56, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35067.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44190.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [{"code": "432", "type": "MS-DRG"}], "standard_charges": [{"minimum": 65348.18, "maximum": 82347.52, "estimated_discounted_cash": 137943.33, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 65348.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 82347.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC", "code_information": [{"code": "434", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23656.42, "maximum": 29810.29, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23656.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29810.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CISTERNOGRAM", "code_information": [{"code": "78630", "type": "CPT"}, {"code": "5208630", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 787.92, "gross_charge": 3752.0, "discounted_cash": 2814.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 787.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 710.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 352.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 352.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 352.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 352.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 352.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CISTRNL LAT CERVCL PUNCT", "code_information": [{"code": "4916105", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1725.0, "discounted_cash": 1293.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CITALOPRAM 10/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314731", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CITALOPRAM 10/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314731", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CITALOPRAM 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302771", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CITALOPRAM 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302771", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CITALOPRAM 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302773", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CITALOPRAM 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302773", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CITRATE/2", "code_information": [{"code": "82507", "type": "CPT"}, {"code": "7252509", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 141.8, "gross_charge": 500.0, "discounted_cash": 375.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 141.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 38.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 38.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 38.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 38.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 38.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CK MB FRACTION", "code_information": [{"code": "82553", "type": "CPT"}, {"code": "4102553", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.87, "gross_charge": 275.0, "discounted_cash": 206.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CL MULT VSD W/REM PUL BAND", "code_information": [{"code": "33677", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2245.77, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2245.77, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2245.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2245.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2245.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLAMP NECK ARTERY", "code_information": [{"code": "61703", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1232.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1232.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1232.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1232.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1232.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLARITHROMYCIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302780", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLARITHROMYCIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302780", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAVICLE COMPLETE", "code_information": [{"code": "73000", "type": "CPT"}, {"code": "4903000", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 200.13, "gross_charge": 953.0, "discounted_cash": 714.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 200.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLAVICLE COMPLETE", "code_information": [{"code": "73000", "type": "CPT"}, {"code": "5013000", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 200.13, "gross_charge": 953.0, "discounted_cash": 714.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 200.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.5, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEAN OUT MASTOID CAVITY", "code_information": [{"code": "69220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAN OUT MASTOID CAVITY", "code_information": [{"code": "69222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 143.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 143.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 143.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 143.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 143.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAR EYELID GLAND W/HEAT", "code_information": [{"code": "207T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAR OUTER EAR CANAL", "code_information": [{"code": "69200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAR OUTER EAR CANAL", "code_information": [{"code": "69205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14066.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 93.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 93.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 93.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 93.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 93.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF TEAR DUCT", "code_information": [{"code": "68530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLIN PT NO REF", "code_information": [{"code": "G0038", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 150MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302814", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 150MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302814", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 75/5 100PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314770", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 75/5 100PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314770", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINICAL SOCIAL WORK SS", "code_information": [{"code": "G0066", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOBAZAM 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302851", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOBAZAM 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302851", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOFARABINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9027", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.77, "maximum": 4.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOMIPRAMINE 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302890", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOMIPRAMINE 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302890", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONAZEPAM .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302910", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONAZEPAM .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302910", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONAZEPAM 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302914", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONAZEPAM 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302914", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE 0.1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302941", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE 0.1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302941", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE 0.2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302945", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE 0.2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302945", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314781", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314781", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOPIDOGREL 75MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302965", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOPIDOGREL 75MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302965", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSD RDUCTN SPLINT ALVEOLUS", "code_information": [{"code": "D7670", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE BLADDER-UTERUS FISTULA", "code_information": [{"code": "51920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 802.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 802.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 802.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 802.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 802.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE BRONCHIAL FISTULA", "code_information": [{"code": "32815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2479.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2479.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2479.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2479.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2479.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE CHEST AFTER DRAINAGE", "code_information": [{"code": "32810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 898.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 898.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 898.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 898.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 898.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE KIDNEY-SKIN FISTULA", "code_information": [{"code": "50520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1068.04, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1068.04, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1068.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1068.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1068.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE MASTOID FISTULA", "code_information": [{"code": "69700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD", "code_information": [{"code": "33675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2098.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2098.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2098.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2098.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2098.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD W/RESECTION", "code_information": [{"code": "33676", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2161.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2161.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2161.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2161.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2161.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1360.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1360.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1360.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1360.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1360.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1365.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1365.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1365.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1365.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1365.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 75.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 75.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 75.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 75.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 75.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR SYSTEM FISTULA", "code_information": [{"code": "68770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TMP MANIPULATION", "code_information": [{"code": "D7820", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TX NOSE/JAW FX", "code_information": [{"code": "21345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX ORBIT W/MANIPULJ", "code_information": [{"code": "21401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX ORBIT W/O MANIPULJ", "code_information": [{"code": "21400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX SEPTAL&NOSE FX", "code_information": [{"code": "21337", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX VERT FX W/MANJ", "code_information": [{"code": "22315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX VERT FX W/O MANJ", "code_information": [{"code": "22310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM IA", "code_information": [{"code": "87324", "type": "CPT"}, {"code": "4105006", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 274.0, "discounted_cash": 205.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM IA/2", "code_information": [{"code": "87324", "type": "CPT"}, {"code": "4107324", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 114.0, "discounted_cash": 85.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM TOXIN A W/OPTIC", "code_information": [{"code": "87803", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF EYELID BY SUTURE", "code_information": [{"code": "67875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 325.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 325.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 325.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 325.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 325.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF SALIVARY FISTULA", "code_information": [{"code": "42600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF SALIVARY FISTULA", "code_information": [{"code": "D7983", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VAGINA", "code_information": [{"code": "57120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 30050.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 508.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 508.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 508.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 508.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 508.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VALVE", "code_information": [{"code": "33600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1729.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1729.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1729.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1729.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1729.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VALVE", "code_information": [{"code": "33602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1654.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1654.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1654.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1654.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1654.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF WINDPIPE LESION", "code_information": [{"code": "31820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE URETER/BOWEL FISTULA", "code_information": [{"code": "50930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1124.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1124.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1124.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1124.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1124.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE URETER/SKIN FISTULA", "code_information": [{"code": "50920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 912.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 912.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 912.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 912.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 912.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR II PRTHRMBN", "code_information": [{"code": "85210", "type": "CPT"}, {"code": "7255210", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.21, "gross_charge": 582.0, "discounted_cash": 436.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR V (LABILE)", "code_information": [{"code": "85220", "type": "CPT"}, {"code": "7255220", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.01, "gross_charge": 724.0, "discounted_cash": 543.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 90.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VII(STABLE)", "code_information": [{"code": "85230", "type": "CPT"}, {"code": "7255230", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 91.32, "gross_charge": 983.0, "discounted_cash": 737.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 91.32, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII RELTD ANTGN", "code_information": [{"code": "85244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 104.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD TX NSL FX W/MNPJ&STABLJ", "code_information": [{"code": "21320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27197", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27198", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX ACROMCLAV DISLC W/MNPJ", "code_information": [{"code": "23545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX ACROMCLAV DISLC WO MNPJ", "code_information": [{"code": "23540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/MNPJ", "code_information": [{"code": "23505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/O MNPJ", "code_information": [{"code": "23500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX GR HMRL TBRS FX W/MNPJ", "code_information": [{"code": "23625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX GR HMRL TBRS FX WO MNPJ", "code_information": [{"code": "23620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX MED ANKLE FX W/MNPJ", "code_information": [{"code": "27762", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX MEDIAL ANKLE FX", "code_information": [{"code": "27760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX", "code_information": [{"code": "27767", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX W/MNPJ", "code_information": [{"code": "27768", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX PROX HUMRL FX W/O MNPJ", "code_information": [{"code": "23600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX PRX HMRL FX MNPJ+-TRACT", "code_information": [{"code": "23605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SCAP FX W/MNPJ +-TRACTJ", "code_information": [{"code": "23575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SCAPULAR FX W/O MNPJ", "code_information": [{"code": "23570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DISLC NECK FX MNPJ", "code_information": [{"code": "23675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC FX GR HMRL TBR", "code_information": [{"code": "23665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC W/MNPJ W/ANES", "code_information": [{"code": "23655", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC W/MNPJ WO ANES", "code_information": [{"code": "23650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2935.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/MNPJ", "code_information": [{"code": "23525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/O MNPJ", "code_information": [{"code": "23520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX", "code_information": [{"code": "27267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX W/MNPJ", "code_information": [{"code": "27268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 504.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 504.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 504.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 504.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 504.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMBN ANT PST COLPRHY", "code_information": [{"code": "57260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 14472.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMBN AP COLPRHY W/NTRCL RPR", "code_information": [{"code": "57265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "estimated_discounted_cash": 25064.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMP EP ABL INTRA AFIB PVI EP3D", "code_information": [{"code": "93656", "type": "CPT"}, {"code": "4613663", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 85758.4, "gross_charge": 90272.0, "discounted_cash": 67704.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 18957.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 8937.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 85758.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26937.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26168.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29925.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29925.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29925.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 85758.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33310.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 67704.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 67704.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMP EP ABL INTRA AFIB PVI EP3D", "code_information": [{"code": "93656", "type": "CPT"}, {"code": "4613663", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 85758.4, "gross_charge": 90272.0, "discounted_cash": 67704.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 18957.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 8937.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 85758.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26937.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26168.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29925.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29925.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29925.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 85758.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33310.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 67704.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 67704.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMP HMRL STM FR SHLD ARTHRO CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5723.97, "maximum": 5723.97, "gross_charge": 27257.0, "discounted_cash": 20442.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 5723.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX REPAIR 1.1CM TO 2.5CM", "code_information": [{"code": "6903131", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CMPLX REPAIR 1.1CM TO 2.5CM", "code_information": [{"code": "6903131", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CMPLX REPAIR 2.6CM TO 7.5CM", "code_information": [{"code": "6903132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CMPLX REPAIR 2.6CM TO 7.5CM", "code_information": [{"code": "6903132", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CMPLX RPR E/N/E/L 1.1-2.5 CM", "code_information": [{"code": "13151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR E/N/E/L 2.6-7.5 CM", "code_information": [{"code": "13152", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR E/N/E/L ADDL 5CM/<", "code_information": [{"code": "13153", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "13131", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "13132", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "13133", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR S/A/L 1.1-2.5 CM", "code_information": [{"code": "13120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR S/A/L 2.6-7.5 CM", "code_information": [{"code": "13121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6440.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR S/A/L ADDL 5 CM/>", "code_information": [{"code": "13122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR TRUNK 1.1-2.5 CM", "code_information": [{"code": "13100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR TRUNK 2.6-7.5 CM", "code_information": [{"code": "13101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14450.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR TRUNK ADDL 5CM/<", "code_information": [{"code": "13102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPRTV DNA ALYS MLT SNPS", "code_information": [{"code": "79U", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPTR OPHTH DX IMG ANT SEGMT", "code_information": [{"code": "92132", "type": "CPT"}], "standard_charges": [{"minimum": 76.13, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPTR OPHTH IMG OPTIC NERVE", "code_information": [{"code": "92133", "type": "CPT"}], "standard_charges": [{"minimum": 76.13, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMRI MORPH FUNCT WO/W", "code_information": [{"code": "75561", "type": "CPT"}, {"code": "5255561", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1826.16, "gross_charge": 8696.0, "discounted_cash": 6522.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1826.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1514.69, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 856.37, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 856.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 856.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 856.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 856.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMV AG DFA", "code_information": [{"code": "87271", "type": "CPT"}, {"code": "7257271", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 284.0, "discounted_cash": 213.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMV IG IV", "code_information": [{"code": "90291", "type": "CPT"}], "standard_charges": [{"minimum": 1802.53, "maximum": 2002.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1802.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2002.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2002.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2002.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2002.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMV QUANT", "code_information": [{"code": "87497", "type": "CPT"}, {"code": "7257499", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 218.45, "gross_charge": 698.0, "discounted_cash": 523.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 218.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMV QUANT/2", "code_information": [{"code": "87497", "type": "CPT"}, {"code": "7257497", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 218.45, "gross_charge": 811.0, "discounted_cash": 608.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 218.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNBP GENE DETC ABNOR ALLELE", "code_information": [{"code": "81187", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNS PATHOGENS 12-25", "code_information": [{"code": "87483", "type": "CPT"}, {"code": "7257483", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2128.5, "gross_charge": 2836.0, "discounted_cash": 2127.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2128.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNS PATHOGENS 12-25/2", "code_information": [{"code": "87483", "type": "CPT"}, {"code": "7257484", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2128.5, "gross_charge": 2396.0, "discounted_cash": 1797.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2128.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNSLT/RPT REFRD SLIDES", "code_information": [{"code": "88321", "type": "CPT"}, {"code": "4118321", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 284.96, "gross_charge": 241.0, "discounted_cash": 180.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 284.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, 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{"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 91.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 91.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNVRT NEPH CATH W/ DIL STRIC", "code_information": [{"code": "C7547", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"standard_charge_dollar": 50643.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63817.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME ACTIVTD", "code_information": [{"code": "85347", "type": "CPT"}, {"code": "4105347", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.72, "gross_charge": 255.0, "discounted_cash": 191.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME ACTIVTD", "code_information": [{"code": "85347", "type": "CPT"}, {"code": "4613585", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.72, "gross_charge": 95.0, "discounted_cash": 71.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME LEE & WHITE", "code_information": [{"code": "85345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME OTR METHOD", "code_information": [{"code": "85348", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 18.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCAINE", "code_information": [{"code": "80353", "type": "CPT"}, {"code": "7252520", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 1286.0, "discounted_cash": 964.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COCCIDIOIDES ANTIBODY", "code_information": 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"plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLECTOMY W/ILEOANAL ANAST", "code_information": [{"code": "44157", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2116.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2116.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2116.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2116.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2116.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLECTOMY W/NEO-RECTUM POUCH", "code_information": [{"code": "44158", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2170.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2170.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2170.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2170.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2170.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLESTIPOL 1GM TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303044", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COLESTIPOL 1GM TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303044", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COLGN CRS-LINK CRN&PACHYMTRY", "code_information": [{"code": "402T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12826.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLGN CRS-LINK CRN&PACHYMTRY", "code_information": [{"code": "418U", "type": "CPT"}], "standard_charges": [{"minimum": 706.25, "maximum": 706.25, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 706.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 706.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLISTIMETHATE INH SOL MG", "code_information": [{"code": "S0142", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLLAGEN CROSS LINKS/5", "code_information": [{"code": "82523", "type": "CPT"}, {"code": "7253950", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 95.3, "gross_charge": 412.0, "discounted_cash": 309.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 95.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGEN CROSS LINKS/6", "code_information": [{"code": "82523", "type": "CPT"}, {"code": "7258252", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 95.3, "gross_charge": 107.0, "discounted_cash": 80.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 95.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGEN MENISCUS IMPLANT", "code_information": [{"code": "G0428", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLAGEN SKIN TEST", "code_information": [{"code": "Q3031", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGENASE, CLOST HIST INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0775", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.32, "maximum": 75.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 68.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 75.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 75.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 75.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 75.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECT BLOOD FROM PICC", "code_information": [{"code": "36592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLECT SWEAT FOR TEST", "code_information": [{"code": "89230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLJ & INTERPJ DATA EA 30 D", "code_information": [{"code": "99091", "type": "CPT"}], "standard_charges": [{"minimum": 50.26, "maximum": 50.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLJ CAPILLARY BLOOD SPEC", "code_information": [{"code": "36416", "type": "CPT"}], "standard_charges": [{"minimum": 3.14, "maximum": 3.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON CA SCREEN;BARIUM ENEMA", "code_information": [{"code": "G0106", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN NOT HI RSK IND", "code_information": [{"code": "G0121", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8814.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN; BARIUM ENEMA", "code_information": [{"code": "G0120", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN; BARIUM ENEMA", "code_information": [{"code": "G0122", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN;BLD-BSD BIOMRK", "code_information": [{"code": "G0327", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON DBL CM STUDY INCLD GLUC", "code_information": [{"code": "74280", "type": "CPT"}, {"code": "4904280", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 362.51, "gross_charge": 1724.0, "discounted_cash": 1293.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 362.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 362.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON MOTILITY 6 HR STUDY", "code_information": [{"code": "91117", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 360.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 324.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 315.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 360.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 360.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 360.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLON SNGL CM STUDY", "code_information": [{"code": "74270", "type": "CPT"}, {"code": "4904270", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 372.12, "gross_charge": 1772.0, "discounted_cash": 1329.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 372.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 273.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 154.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 154.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONIC LAVAGE 1L PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314380", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 484.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COLONIC LAVAGE 1L PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314380", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 484.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COLONIC LAVAGE 4L PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314381", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COLONIC LAVAGE 4L PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314381", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COLONOSCOPY & POLYPECTOMY", "code_information": [{"code": "44392", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY AND BIOPSY", "code_information": [{"code": "45380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7352.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FOR BLEEDING", "code_information": [{"code": "44391", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FOR FOREIGN BODY", "code_information": [{"code": "44390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY SUBMUCOUS NJX", "code_information": [{"code": "45381", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5639.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY THRU STOMA SPX", "code_information": [{"code": "44388", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8811.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ABLATION", "code_information": [{"code": "45388", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5795.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/BALLOON DILAT", "code_information": [{"code": "45386", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4243.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/BAND LIGATION", "code_information": [{"code": "45398", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/CONTROL BLEED", "code_information": [{"code": "45382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5141.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "44408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "45393", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DILATION", "code_information": [{"code": "44405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ENDOSCOPE US", "code_information": [{"code": "45391", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8406.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ENDOSCOPIC FNB", "code_information": [{"code": "45392", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14146.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/FB REMOVAL", "code_information": [{"code": "45379", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/INJECTION", "code_information": [{"code": "44404", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/LESION REMOVAL", "code_information": [{"code": "45384", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6814.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/LESION REMOVAL", "code_information": [{"code": "45385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_percentage": 75.0, "possible_amount": 1372.23, "count": "1 through 10", "median_amount": 1372.23, "methodology": "percent of total billed charges", "10th_percentile": 1372.23, "90th_percentile": 1372.23}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/NDL ASPIR/BX", "code_information": [{"code": "44407", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "44403", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "45390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9043.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/SNARE", "code_information": [{"code": "44394", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8487.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "44402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "45389", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ULTRASOUND", "code_information": [{"code": "44406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY WITH ABLATION", "code_information": [{"code": "44401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY WITH BIOPSY", "code_information": [{"code": "44389", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLOR CONT LENS", "code_information": [{"code": "S0514", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLORECTAL SCRN; HI RISK IND", "code_information": [{"code": "G0105", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9029.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLORIC VESTIBLE TEST BL 4", "code_information": [{"code": "92537", "type": "CPT"}, {"code": "4802537", "type": "CDM"}, {"code": "471", "type": "RC"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "gross_charge": 2820.0, "discounted_cash": 2115.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY", "code_information": [{"code": "44320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1093.26, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1093.26, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1093.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1093.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1093.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY WITH BIOPSIES", "code_information": [{"code": "44322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 902.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 902.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 902.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 902.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 902.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY EXTRAPERITONEAL", "code_information": [{"code": "57282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 24362.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 505.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 505.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 505.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 505.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 505.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY INTRAPERITONEAL", "code_information": [{"code": "57283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14015.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 680.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 680.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 680.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 680.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 680.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY, MIN/INV, EX-PERIT", "code_information": [{"code": "C9778", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMA STIMULATION PER DIEM", "code_information": [{"code": "S9056", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMBINATION SIT TO STAND SYS", "code_information": [{"code": "E0637", "type": "HCPCS"}], "standard_charges": [{"minimum": 3149.23, "maximum": 3601.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3241.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3149.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3601.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3601.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3601.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC", "code_information": [{"code": "429", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 376952.65, "estimated_discounted_cash": 206501.06, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 299136.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 376952.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC", "code_information": [{"code": "430", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 241289.7, "estimated_discounted_cash": 382754.8, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 191479.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 241289.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMM SVCS BY RHC/FQHC 5 MIN", "code_information": [{"code": "G0071", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMMUNITY/WORK REINTEGRATION", "code_information": [{"code": "97537", "type": "CPT"}], "standard_charges": [{"minimum": 22.14, "maximum": 75.95, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 68.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 66.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 75.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 75.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 75.95, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.14, 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{"code": "4106210", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "gross_charge": 284.0, "discounted_cash": 213.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPL GIFT CASE RATE", "code_information": [{"code": "S4013", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPL RPLCMT PICC RS&I", "code_information": [{"code": "36584", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPL ZIFT CASE RATE", "code_information": [{"code": "S4014", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT AG EA", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "7256136", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.25, "gross_charge": 75.0, "discounted_cash": 56.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.25, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT AG EA/10", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "7256332", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.25, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT AG EA/11", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "7256333", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.25, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.25, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT AG EA/12", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "7256334", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.25, "gross_charge": 393.0, "discounted_cash": 294.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT AG EA/2", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "4106332", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.25, "gross_charge": 393.0, "discounted_cash": 294.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.25, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT AG EA/2", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "7256148", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.25, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.25, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT AG EA/3", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "4106333", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.25, "gross_charge": 393.0, "discounted_cash": 294.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.25, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT AG EA/5", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "7256161", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.25, "gross_charge": 235.0, "discounted_cash": 176.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.25, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT FIXATION EACH", "code_information": [{"code": "86171", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT TOTAL CH50", "code_information": [{"code": "86162", "type": "CPT"}, {"code": "7256162", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 103.62, "gross_charge": 303.0, "discounted_cash": 227.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 103.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMNT FUNCT ACTIV EA", "code_information": [{"code": "86161", "type": "CPT"}, {"code": "7258308", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.25, "gross_charge": 202.0, "discounted_cash": 151.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.25, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE IVF NOS CASE RATE", "code_information": [{"code": "S4015", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETE REMOVAL OF VULVA", "code_information": [{"code": "56625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLETED EPSDT", "code_information": [{"code": "S0302", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETION PNEUMONECTOMY", "code_information": [{"code": "32488", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2252.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2252.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2252.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2252.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2252.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLEX CYSTOMETROGRAM", "code_information": [{"code": "51726", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLEX LYMPHEDEMA THERAPY,", "code_information": [{"code": "S8950", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [{"code": "381", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5420.52, "maximum": 50443.32, "estimated_discounted_cash": 58370.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 23056.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6960.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11467.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45398.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 24261.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 47769.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12066.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7323.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7733.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50443.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12742.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 25618.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12742.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7733.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 25618.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50443.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50443.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7733.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25618.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12742.18, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11404.62, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 17061.27, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 49510.04, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5420.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35974.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45332.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "380", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5424.44, "maximum": 82096.49, "estimated_discounted_cash": 74670.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18581.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12844.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9864.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32569.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10379.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19552.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13515.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34270.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14271.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 20646.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36189.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10960.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36189.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14271.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 20646.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10960.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36189.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20646.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14271.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10960.93, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 23657.22, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5424.44, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7651.35, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11587.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 65148.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 82096.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITHOUT CC/MCC", "code_information": [{"code": "382", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7814.42, "maximum": 33496.3, "estimated_discounted_cash": 57289.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27320.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18447.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13024.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11060.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13705.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19410.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 28747.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11638.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14472.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 20497.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30356.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12289.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14472.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 20497.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30356.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12289.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30356.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20497.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14472.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12289.39, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9212.93, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13070.57, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 24211.66, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7814.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26581.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33496.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [{"code": "920", "type": "MS-DRG"}], "standard_charges": [{"minimum": 33278.36, "maximum": 41935.23, "estimated_discounted_cash": 61193.96, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33278.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41935.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [{"code": "919", "type": "MS-DRG"}], "standard_charges": [{"minimum": 60786.22, "maximum": 76598.84, "estimated_discounted_cash": 96994.52, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 60786.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 76598.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITHOUT CC/MCC", "code_information": [{"code": "921", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22856.26, "maximum": 28801.97, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22856.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28801.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPNENT HUM STM FRE DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013173", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1682.73, "maximum": 1682.73, "gross_charge": 8013.0, "discounted_cash": 6009.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1682.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPONENT VEN OUTFLOW", "code_information": [{"code": "C1750", "type": "HCPCS"}, {"code": "8173799", "type": "CDM"}], "standard_charges": [{"minimum": 6025.11, "maximum": 6025.11, "gross_charge": 28691.0, "discounted_cash": 21518.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6025.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT 2 VEINS", "code_information": [{"code": "35682", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 370.26, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 370.26, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 370.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 370.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 370.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT 3/> SEGMT", "code_information": [{"code": "35683", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 435.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 435.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 435.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 435.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 435.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT PROS&VEIN", "code_information": [{"code": "35681", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 83.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 83.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 83.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 83.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 83.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPOSITE SKIN GRAFT", "code_information": [{"code": "15760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPRE FUL BDY 3D MTN ALYS", "code_information": [{"code": "693T", "type": "CPT"}], "standard_charges": [{"minimum": 350.5, "maximum": 350.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 350.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 350.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE OPH EXAM EST PT 1/>", "code_information": [{"code": "92014", "type": "CPT"}], "standard_charges": [{"minimum": 113.36, "maximum": 180.44, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 113.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 162.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 157.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 113.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 113.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 113.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 113.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE OPH EXAM NEW PT 1/>", "code_information": [{"code": "92004", "type": "CPT"}], "standard_charges": [{"minimum": 138.37, "maximum": 180.44, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 138.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 162.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 157.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 138.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 138.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 138.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 138.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPREHENSIVE HEARING TEST", "code_information": [{"code": "92557", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPREHENSVE ORAL EVALUATION", "code_information": [{"code": "D0150", "type": "HCPCS"}], "standard_charges": [{"minimum": 2278.99, "maximum": 2606.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2345.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2278.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2606.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2606.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2606.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRESSION BANDAGE", "code_information": [{"code": "S8431", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMT GENE", "code_information": [{"code": "32U", "type": "CPT"}], "standard_charges": [{"minimum": 174.81, "maximum": 174.81, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONCENTRATION INF AGENT", "code_information": [{"code": "87015", "type": "CPT"}, {"code": "4107015", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.05, "gross_charge": 199.0, "discounted_cash": 149.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.05, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONCENTRATION INF AGENT", "code_information": [{"code": "87015", "type": "CPT"}, {"code": "7257014", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.05, "gross_charge": 199.0, "discounted_cash": 149.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONCENTRATION INF AGENT/2", "code_information": [{"code": "87015", "type": "CPT"}, {"code": "4107016", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.05, "gross_charge": 199.0, "discounted_cash": 149.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONCENTRATION INF AGENT/2", "code_information": [{"code": "87015", "type": "CPT"}, {"code": "7257015", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.05, "gross_charge": 119.0, "discounted_cash": 89.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.05, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [{"code": "212", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 454961.47, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 361041.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 454961.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION", "code_information": [{"code": "317", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 279756.47, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 23122.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17876.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 35504.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 64843.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 68230.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18810.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 37359.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 24329.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 72049.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 25691.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19862.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39450.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19862.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39450.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 25691.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 72049.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 72049.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25691.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39450.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19862.94, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 14257.73, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 59060.86, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11853.4, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 22865.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 222005.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 279756.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITH CC", "code_information": [{"code": "89", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16475.52, "maximum": 114235.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 39086.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71400.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 102810.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29202.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30727.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 41127.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 75129.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 108180.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 114235.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 43429.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 79334.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32447.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 114235.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32447.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 43429.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 79334.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32447.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 43429.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 79334.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 114235.4, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 29354.31, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 77884.61, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16475.52, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 47748.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 36475.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45964.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITH MCC", "code_information": [{"code": "88", "type": "MS-DRG"}], "standard_charges": [{"minimum": 44882.46, "maximum": 56557.96, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44882.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 56557.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITHOUT CC/MCC", "code_information": [{"code": "90", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27331.89, "maximum": 34441.86, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27331.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONJ ESTROGEN .3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303065", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CONJ ESTROGEN .3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303065", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "546", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38295.19, "maximum": 48257.1, "estimated_discounted_cash": 68910.19, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38295.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 48257.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "545", "type": "MS-DRG"}], "standard_charges": [{"minimum": 82397.4, "maximum": 103831.85, "estimated_discounted_cash": 95417.07, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 82397.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 103831.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "547", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8217.54, "maximum": 51000.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17292.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45900.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25694.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12367.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 27036.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 48297.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18195.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13013.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 51000.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19213.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13741.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28549.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28549.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 51000.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19213.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13741.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51000.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13741.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28549.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19213.66, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 42824.08, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8217.54, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10153.53, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16986.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27763.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34985.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONNECTOR IMP ALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 602.49, "maximum": 602.49, "gross_charge": 2869.0, "discounted_cash": 2151.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 602.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR NERVE AXOGUARD", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4021024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2769.9, "maximum": 2769.9, "gross_charge": 13190.0, "discounted_cash": 9892.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2769.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSLTJ COMPRE RVW REC REPRT", "code_information": [{"code": "88325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 441.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 441.25, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 210.35, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 210.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 210.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 210.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 210.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSLTJ&REPRT MATRL PREP SLD", "code_information": [{"code": "88323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 188.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 188.12, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 156.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 156.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 156.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 156.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 156.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BLADDER OPENING", "code_information": [{"code": "51980", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 736.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 736.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 736.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 736.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 736.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1344.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1344.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1344.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1344.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1344.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1702.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1702.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1702.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1702.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1702.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT THUMB REPLACEMENT", "code_information": [{"code": "26550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT VAGINA WITH GRAFT", "code_information": [{"code": "57292", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 817.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 817.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 817.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 817.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 817.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1668.44, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1668.44, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1668.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1668.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1668.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46735", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1971.04, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1971.04, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1971.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1971.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1971.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1869.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1869.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1869.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1869.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1869.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF VAGINA", "code_information": [{"code": "57291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSULT/FROZEN ADD", "code_information": [{"code": "88332", "type": "CPT"}, {"code": "4308332", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 42.98, "gross_charge": 238.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSULT/FROZEN SEC", "code_information": [{"code": "88331", "type": "CPT"}, {"code": "4308331", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 149.16, "gross_charge": 1272.0, "discounted_cash": 954.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 96.83, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 96.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 96.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 96.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 96.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 96.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSULT/SURGERY", "code_information": [{"code": "88329", "type": "CPT"}, {"code": "4308329", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 123.11, "gross_charge": 216.0, "discounted_cash": 162.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 123.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 53.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 53.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 53.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 53.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 53.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSULTATION WITH FAMILY", "code_information": [{"code": "90887", "type": "CPT"}], "standard_charges": [{"minimum": 66.21, "maximum": 66.21, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 66.21, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 66.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 66.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 66.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 66.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT AER MED OBSTR 1STHR", "code_information": [{"code": "94644", "type": "CPT"}, {"code": "5504644", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 44.79, "maximum": 165.85, "gross_charge": 525.0, "discounted_cash": 393.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 44.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 44.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT AER MED OBSTR ADDHR", "code_information": [{"code": "94645", "type": "CPT"}, {"code": "5504645", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 16.71, "maximum": 16.71, "gross_charge": 844.0, "discounted_cash": 633.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR ANALYSIS I&R", "code_information": [{"code": "95251", "type": "CPT"}], "standard_charges": [{"minimum": 39.75, "maximum": 80.39, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE 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"plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 39.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 39.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 39.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR PT PROV EQP", "code_information": [{"code": "95249", "type": "CPT"}], "standard_charges": [{"minimum": 76.13, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT INTRAOP NEURO MONITOR", "code_information": [{"code": "G0453", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 561.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 561.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 561.28, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITG APHAKIA 1", "code_information": [{"code": "92311", "type": "CPT"}], "standard_charges": [{"minimum": 92.09, "maximum": 542.27, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 488.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 474.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 542.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 542.27, "methodology": "fee 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"plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 102.38, "methodology": "fee 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SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 134.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 134.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 134.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTOUR CRANIAL BONE LESION", "code_information": [{"code": "21181", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTOUR OF FACE BONE LESION", "code_information": [{"code": "21029", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRACEPT IUD", "code_information": [{"code": "S4989", "type": "HCPCS"}], "standard_charges": [{"minimum": 245.82, "maximum": 273.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 245.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 273.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 273.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 273.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 273.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRACEPTIVE HORMONE PATCH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7304", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.78, "maximum": 46.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 41.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 46.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 46.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 46.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 46.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRACEPTIVE PILLS FOR BC", "code_information": [{"code": "S4993", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.2, "maximum": 1.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70010", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 506.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 506.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 222.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 222.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 222.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 222.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 222.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70015", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 715.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 210.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 152.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 152.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 152.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 152.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 152.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42971", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 459.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 459.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 459.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 459.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 459.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42972", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NOSEBLEED", "code_information": [{"code": "30901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1310.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NOSEBLEED", "code_information": [{"code": "30903", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1371.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NOSEBLEED", "code_information": [{"code": "30905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10287.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42961", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42962", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17320.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRST EVAL EXISTNG CVD", "code_information": [{"code": "4906598", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1623.0, "discounted_cash": 1217.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTRST EVAL EXISTNG CVD", "code_information": [{"code": "4916598", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1623.0, "discounted_cash": 1217.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CONVERSION ARRHYTHMIA", "code_information": [{"code": "92960", "type": "CPT"}, {"code": "4603286", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 820.02, "gross_charge": 6268.0, "discounted_cash": 4701.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 324.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 738.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 717.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 820.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 820.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 820.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 324.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 324.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 324.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 324.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONVERSION EXT BIL DRG CATH", "code_information": [{"code": "47535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONVERT EXT BILI DRAIN", "code_information": [{"code": "4917986", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 14924.0, "discounted_cash": 11193.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONVERT NEPHROSTOMY CATHETER", "code_information": [{"code": "50434", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONVRT NEPHOST TO URETER", "code_information": [{"code": "4910434", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5703.0, "discounted_cash": 4277.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CONZ OF CERVIX W/SCOPE LEEP", "code_information": [{"code": "57461", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COOMBS DIRECT EA", "code_information": [{"code": "86880", "type": "CPT"}, {"code": "4106031", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.38, "gross_charge": 156.0, "discounted_cash": 117.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27.38, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOMBS DIRECT EA", "code_information": [{"code": "86880", "type": "CPT"}, {"code": "7146031", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.38, "gross_charge": 156.0, "discounted_cash": 117.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOMBS INDIRECT EA", "code_information": [{"code": "86885", "type": "CPT"}, {"code": "4106885", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.16, "gross_charge": 219.0, "discounted_cash": 164.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 29.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOMBS INDIRECT EA", "code_information": [{"code": "86885", "type": "CPT"}, {"code": "7146885", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.16, "gross_charge": 74.0, "discounted_cash": 55.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 29.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOMBS INDIRECT EA AB TITR", "code_information": [{"code": "86886", "type": "CPT"}, {"code": "4106027", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 219.0, "discounted_cash": 164.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOMBS INDIRECT EA AB TITR", "code_information": [{"code": "86886", "type": "CPT"}, {"code": "4106032", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 504.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOMBS INDIRECT EA AB TITR", "code_information": [{"code": "86886", "type": "CPT"}, {"code": "7146027", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 116.0, "discounted_cash": 87.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPPER CU 64 DOTATATE DIAG", "code_information": [{"code": "A9592", "type": "HCPCS"}], "standard_charges": [{"minimum": 1349.62, "maximum": 1499.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1349.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1499.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1499.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1499.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1499.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPPER/3", "code_information": [{"code": "82525", "type": "CPT"}, {"code": "7252525", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.29, "gross_charge": 335.0, "discounted_cash": 251.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.29, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPPER/4", "code_information": [{"code": "82525", "type": "CPT"}, {"code": "7252526", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.29, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPY NUMBER SEQUENCE ALYS", "code_information": [{"code": "156U", "type": "CPT"}], "standard_charges": [{"minimum": 1740.0, "maximum": 1740.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7516", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ILIC/FEM ANGIO", "code_information": [{"code": "C7517", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ANGIO/VENT W/DRUG ADMIN", "code_information": [{"code": "C7558", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR ANGIO/VENT W/FFR", "code_information": [{"code": "C7557", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ANGPLSTY ADD", "code_information": [{"code": "92921", "type": "CPT"}, {"code": "4612921", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16799.8, "gross_charge": 17684.0, "discounted_cash": 13263.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3713.64, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 16799.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 16799.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6525.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 13263.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 13263.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ANGPLSTY INIT", "code_information": [{"code": "92920", "type": "CPT"}, {"code": "4612919", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25570.0, "gross_charge": 26088.0, "discounted_cash": 19566.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 5478.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 24783.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 24783.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9626.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 19566.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 19566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ARTERY DISEASE MRNA", "code_information": [{"code": "81493", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3880.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3880.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ATHER STNT APLST ADD", "code_information": [{"code": "92934", "type": "CPT"}, {"code": "4612934", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54832.1, "gross_charge": 57718.0, "discounted_cash": 43288.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 12120.78, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 54832.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 54832.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21297.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 43288.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 43288.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ATHER STNT APLST INI", "code_information": [{"code": "92933", "type": "CPT"}, {"code": "4612933", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51118.55, "gross_charge": 53809.0, "discounted_cash": 40356.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 11299.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 51118.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 51118.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19855.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 40356.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 40356.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ATHERECT APLAS INIT", "code_information": [{"code": "92924", "type": "CPT"}, {"code": "4612924", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 39544.7, "gross_charge": 41626.0, "discounted_cash": 31219.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 8741.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 39544.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 39544.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15359.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 31219.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 31219.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS DOUBLE OSTEOT", "code_information": [{"code": "28299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 13541.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS DSTL MTAR OSTEO", "code_information": [{"code": "28296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS JT ARTHRD", "code_information": [{"code": "28297", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 54695.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS PRX MTAR OSTEOT", "code_information": [{"code": "28295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS PRX PHLX OSTEOT", "code_information": [{"code": "28298", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS RSC PRX PHLX BS", "code_information": [{"code": "28292", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 26156.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1314.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR STNT ANGIO ADD", "code_information": [{"code": "92929", "type": "CPT"}, {"code": "4612929", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51119.5, "gross_charge": 53810.0, "discounted_cash": 40357.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 11300.1, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 51119.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 51119.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19855.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 40357.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 40357.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR STNT ANGIO INIT", "code_information": [{"code": "92928", "type": "CPT"}, {"code": "4612928", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51119.5, "gross_charge": 53810.0, "discounted_cash": 40357.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 11300.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 51119.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 51119.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19855.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 40357.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 40357.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR THROMBLYS-INTRA COR", "code_information": [{"code": "92975", "type": "CPT"}, {"code": "4612975", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 5384.6, "gross_charge": 5668.0, "discounted_cash": 4251.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1190.28, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 5384.6, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 415.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 783.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 761.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 870.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 870.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 870.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "standard_charge_dollar": 1417.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "standard_charge_dollar": 1983.8, "methodology": "fee schedule"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "standard_charge_dollar": 1700.4, "methodology": "fee schedule"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "standard_charge_dollar": 2834.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 415.46, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "standard_charge_dollar": 1417.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 5384.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 415.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 415.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 415.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2091.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 4251.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 4251.0, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 3684.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ FLOW RESRV", "code_information": [{"code": "C7519", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7518", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ILIC/FEM ANG", "code_information": [{"code": "C7520", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORD BLOOD HARVESTING", "code_information": [{"code": "S2140", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORD BLOOD-DERIVED STEM-CELL", "code_information": [{"code": "S2142", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORE NDL BX LNG/MED PERQ", "code_information": [{"code": "32408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "estimated_discounted_cash": 5180.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORF RELATED SERV 15 MINS EA", "code_information": [{"code": "G0409", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORF SKILLED NURSING SERVICE", "code_information": [{"code": "G0128", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORNEAL HYSTERESIS DETER", "code_information": [{"code": "92145", "type": "CPT"}], "standard_charges": [{"minimum": 79.23, "maximum": 90.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 81.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 90.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 90.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 90.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL SMEAR", "code_information": [{"code": "65430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TISSUE TRANSPLANT", "code_information": [{"code": "65767", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRNSPL ENDOTHELIAL", "code_information": [{"code": "65756", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY BYPASS/REOP", "code_information": [{"code": "33530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 484.1, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 484.1, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 484.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 484.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 484.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY CORRECTION", "code_information": [{"code": "33502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1300.44, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1300.44, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1300.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1300.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1300.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY GRAFT", "code_information": [{"code": "33503", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1322.1, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1322.1, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1322.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1322.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1322.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY GRAFT", "code_information": [{"code": "33504", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1480.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1480.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1480.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1480.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1480.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [{"code": "233", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 319867.52, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24838.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19231.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53844.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 35993.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20236.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26136.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 56657.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 37873.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21368.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39992.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27598.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59828.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39992.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27598.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21368.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59828.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27598.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21368.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59828.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39992.86, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 12732.68, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 20130.94, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10073.95, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 40976.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 253835.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 319867.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [{"code": "234", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 228553.91, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 50440.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29617.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20144.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15596.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16411.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 53075.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO 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"methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 39578.29, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13141.01, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9075.95, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6905.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 181372.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 228553.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [{"code": "231", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 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"plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 85893.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36649.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29847.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 31518.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 55319.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 90701.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38700.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 31518.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 55319.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38700.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 90701.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38700.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 31518.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 90701.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 55319.36, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 26797.34, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 17076.93, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 42677.96, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13523.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 279889.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 352698.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [{"code": "232", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 253653.12, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 76215.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34730.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21509.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26274.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22632.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 80196.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 27646.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36544.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29194.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 84684.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23899.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38589.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 84684.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38589.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23899.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29194.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38589.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23899.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 84684.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29194.25, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 72396.25, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 14873.49, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 29989.64, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11312.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 201290.45, 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"plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 60114.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 63254.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 47923.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 41168.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 88053.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50605.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 43472.07, "methodology": "case rate"}, {"payer_name": "BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 106591.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134319.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONECTOMY", "code_information": [{"code": "D7251", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONERS AUTOPSY (NECROPSY)", "code_information": [{"code": "88045", "type": "CPT"}], "standard_charges": [{"minimum": 58.62, "maximum": 58.62, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT FINGER DEFORMITY", "code_information": [{"code": "26567", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT INVERTED NIPPLE(S)", "code_information": [{"code": "19355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH 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coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT MALROTATION OF BOWEL", "code_information": [{"code": "44055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT METACARPAL FLAW", "code_information": [{"code": "26565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 961.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 961.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 961.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 961.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 961.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR 6.0 CM/<", "code_information": [{"code": "11920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR EA 20.0CM", "code_information": [{"code": "11922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT SKN COLOR 6.1-20.0CM", "code_information": [{"code": "11921", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION EYELID W/IMPLANT", "code_information": [{"code": "67912", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65772", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65775", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF BLADDER DEFECT", "code_information": [{"code": "51940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1653.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1653.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1653.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1653.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1653.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRJ HALUX RIGDUS W/IMPLT", "code_information": [{"code": "28291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 36726.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRJ HALUX RIGDUS W/O IMPLT", "code_information": [{"code": "28289", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 20272.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORTICORELIN OVINE TRIFLUTAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0795", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.7, "maximum": 9.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTICOSTERONE", "code_information": [{"code": "82528", "type": "CPT"}, {"code": "7258225", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 114.79, "gross_charge": 491.0, "discounted_cash": 368.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 114.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.45, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL FREE/2", "code_information": [{"code": "82530", "type": "CPT"}, {"code": "7252534", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.23, "gross_charge": 146.0, "discounted_cash": 109.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 85.23, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL FREE/3", "code_information": [{"code": "82530", "type": "CPT"}, {"code": "7252535", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.23, "gross_charge": 475.0, "discounted_cash": 356.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 85.23, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL TOTAL", "code_information": [{"code": "82533", "type": "CPT"}, {"code": "4102533", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.15, "gross_charge": 519.0, "discounted_cash": 389.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL TOTAL", "code_information": [{"code": "82533", "type": "CPT"}, {"code": "4162533", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.15, "gross_charge": 209.0, "discounted_cash": 156.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.15, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL TOTAL/2", "code_information": [{"code": "82533", "type": "CPT"}, {"code": "7252528", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.15, "gross_charge": 94.0, "discounted_cash": 70.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.15, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL TOTAL/3", "code_information": [{"code": "82533", "type": "CPT"}, {"code": "4102537", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.15, "gross_charge": 209.0, "discounted_cash": 156.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL TOTAL/4", "code_information": [{"code": "82533", "type": "CPT"}, {"code": "7252533", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.15, "gross_charge": 296.0, "discounted_cash": 222.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.15, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COTTON-LEUNG STN", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "8173920", "type": "CDM"}], "standard_charges": [{"minimum": 78.33, "maximum": 78.33, "gross_charge": 373.0, "discounted_cash": 279.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COUNSEL IMMUNE <21  5-15 M", "code_information": [{"code": "G0315", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COUNSEL IMMUNE <21 16-30 M", "code_information": [{"code": "G0314", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE", "code_information": [{"code": "65778", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE SUTURE", "code_information": [{"code": "65779", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COVID 19", "code_information": [{"code": "U0002", "type": "HCPCS"}, {"code": "4105386", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 51.31, "maximum": 51.31, "gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 51.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 51.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVID 19", "code_information": [{"code": "U0002", "type": "HCPCS"}, {"code": "7250043", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 51.31, "maximum": 51.31, "gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 51.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 51.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPAP INITIAL", "code_information": [{"code": "94660", "type": "CPT"}, {"code": "5500600", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 60.75, "maximum": 298.43, "gross_charge": 2813.0, "discounted_cash": 2109.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 260.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPAP MANAGEMENT DLY", "code_information": [{"code": "94660", "type": "CPT"}, {"code": "5504661", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 60.75, "maximum": 298.43, "gross_charge": 615.0, "discounted_cash": 461.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 260.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPR", "code_information": [{"code": "92950", "type": "CPT"}, {"code": "4619130", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 392.98, "gross_charge": 2251.0, "discounted_cash": 1688.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPR", "code_information": [{"code": "92950", "type": "CPT"}, {"code": "5500200", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 392.98, "gross_charge": 2251.0, "discounted_cash": 1688.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPR CARDIOPULM RESUSC", "code_information": [{"code": "92950", "type": "CPT"}, {"code": "6100535", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 392.98, "gross_charge": 2251.0, "discounted_cash": 1688.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 309.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPTR OPHTH DX IMG POST SEGMT", "code_information": [{"code": "92134", "type": "CPT"}], "standard_charges": [{"minimum": 76.13, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPTR-ASST DIR MS PX", "code_information": [{"code": "20985", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 145.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 145.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 145.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 145.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 145.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPTRIZED CORNEAL TOPOGRAPHY", "code_information": [{"code": "92025", "type": "CPT"}], "standard_charges": [{"minimum": 35.1, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [{"code": "73", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10890.62, "maximum": 72266.93, "estimated_discounted_cash": 66094.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 65039.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 33719.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21547.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16974.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 35480.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 68436.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17861.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22673.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23942.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 72266.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18861.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 37466.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23942.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 72266.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 37466.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18861.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 37466.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23942.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18861.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 72266.93, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 56417.78, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 14932.2, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10890.62, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 30199.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 53265.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 67122.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [{"code": "74", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34224.62, "maximum": 43127.64, "estimated_discounted_cash": 62647.4, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 34224.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 43127.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIAL REMOLDING ORTHOSIS", "code_information": [{"code": "S1040", "type": "HCPCS"}], "standard_charges": [{"minimum": 2143.8, "maximum": 2451.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2206.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2143.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2451.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2451.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2451.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2388.29, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2388.29, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2388.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2388.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2388.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61581", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2625.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2625.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2625.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2625.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2625.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61582", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2738.95, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2738.95, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2738.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2738.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2738.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61583", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2761.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2761.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2761.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2761.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2761.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "26", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15583.18, "maximum": 130085.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 84013.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 23231.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29432.73, "methodology": "case 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"methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32703.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50001.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93349.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 25813.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32703.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50001.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93349.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32703.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25813.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50001.21, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 19662.6, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 72627.16, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 15583.18, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 32675.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 103231.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 130085.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "25", "type": "MS-DRG"}], "standard_charges": [{"minimum": 150959.53, "maximum": 190229.38, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 150959.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 190229.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 32501.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 61472.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 37832.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 34320.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 107029.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39950.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 64913.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39950.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 34320.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 64913.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 107029.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 34320.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39950.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER 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"methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 71640.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32756.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 75650.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 123111.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 44907.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 123111.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 75650.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32756.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 44907.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 123111.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 75650.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32756.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 44907.33, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 19369.07, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 58138.52, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 43378.52, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 25865.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 190257.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 239750.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [{"code": "24", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9751.72, "maximum": 163669.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 73074.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42945.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24575.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19698.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25858.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76891.16, "methodology": "case 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rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 81194.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 47718.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27306.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 81194.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27306.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21887.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 47718.04, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9751.72, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 23198.01, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 50112.75, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 12496.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 129882.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 163669.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRD C HRT DS 9 GEN 12 VRNTS", "code_information": [{"code": "417U", "type": "CPT"}], "standard_charges": [{"minimum": 2842.53, "maximum": 2842.53, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2842.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2842.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CAD ALYS 3 PRTN 3 PARAM", "code_information": [{"code": "308U", "type": "CPT"}], "standard_charges": [{"minimum": 390.75, "maximum": 390.75, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CERAMIDES LIQ CHROM PLSM", "code_information": [{"code": "119U", "type": "CPT"}], "standard_charges": [{"minimum": 83.76, "maximum": 83.76, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 83.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 83.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CV DS ALY 4 PRTN PLM ALG", "code_information": [{"code": "309U", "type": "CPT"}], "standard_charges": [{"minimum": 390.75, "maximum": 390.75, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD HRT TRNSPL MRNA 1283 GEN", "code_information": [{"code": "87U", "type": "CPT"}], "standard_charges": [{"minimum": 3159.42, "maximum": 3159.42, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3159.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3159.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE EARDRUM OPENING", "code_information": [{"code": "69433", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 117.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 117.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 117.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 117.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 117.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE EARDRUM OPENING", "code_information": [{"code": "69436", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12769.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE NEW TUBAL OPENING", "code_information": [{"code": "58770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 845.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 845.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 845.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 845.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 845.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE PASSAGE TO KIDNEY", "code_information": [{"code": "52334", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR DUCT DRAIN", "code_information": [{"code": "68745", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR DUCT DRAIN", "code_information": [{"code": "68750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR SAC DRAIN", "code_information": [{"code": "68720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATINE", "code_information": [{"code": "82540", "type": "CPT"}, {"code": "7252540", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 23.65, "gross_charge": 165.0, "discounted_cash": 123.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 23.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATINE ISOFORMS", "code_information": [{"code": "82554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 60.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 60.52, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATINE KINASE ISONZ", "code_information": [{"code": "82552", "type": "CPT"}, {"code": "7252552", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.29, "gross_charge": 195.0, "discounted_cash": 146.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 68.29, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATINE KINASE TOTAL", "code_information": [{"code": "82550", "type": "CPT"}, {"code": "4102550", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.22, "gross_charge": 108.0, "discounted_cash": 81.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATINE KINASE TOTAL", "code_information": [{"code": "82550", "type": "CPT"}, {"code": "7252550", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.22, "gross_charge": 182.0, "discounted_cash": 136.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE BLOOD/2", "code_information": [{"code": "82565", "type": "CPT"}, {"code": "4102565", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.13, "gross_charge": 172.0, "discounted_cash": 129.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE CLEARANCE", "code_information": [{"code": "82575", "type": "CPT"}, {"code": "4102575", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.18, "gross_charge": 391.0, "discounted_cash": 293.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 48.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.2, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE OTHR SRCE", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "4102570", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 159.0, "discounted_cash": 119.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE OTHR SRCE", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "7250396", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 170.0, "discounted_cash": 127.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE OTHR SRCE/2", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "7252570", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 27.0, "discounted_cash": 20.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE OTHR SRCE/3", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "4102573", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 170.0, "discounted_cash": 127.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE OTHR SRCE/3", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "7252571", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATININE OTHR SRCE/5", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "7252574", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRH STIMULATION PANEL", "code_information": [{"code": "80412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1680.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1680.83, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 460.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 460.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 460.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 460.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 460.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 801.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 801.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRICOTRACHEAL RESECTION", "code_information": [{"code": "31592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRISIS INTERVENTION PER DAY", "code_information": [{"code": "S9485", "type": "HCPCS"}, {"code": "6109485", "type": "CDM"}, {"code": "900", "type": "RC"}], "standard_charges": [{"minimum": 468.72, "maximum": 847.44, "gross_charge": 2232.0, "discounted_cash": 1674.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 468.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 762.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 741.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 847.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 847.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 847.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRISIS INTERVENTION PER HOUR", "code_information": [{"code": "S9484", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRIT CARE E&M 30-74 MIN", "code_information": [{"code": "99291", "type": "CPT"}, {"code": "6100514", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 271.33, "maximum": 271.33, "gross_charge": 8974.0, "discounted_cash": 6730.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 271.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 271.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 271.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 271.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 271.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRIT CARE E&M 30-74 MIN", "code_information": [{"code": "99291", "type": "CPT"}, {"code": "6169291", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 271.33, "maximum": 271.33, "gross_charge": 8974.0, "discounted_cash": 6730.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 271.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 271.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 271.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 271.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 271.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRITICAL CR E&M ADDL 30", "code_information": [{"code": "99292", "type": "CPT"}, {"code": "6103055", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 119.24, "maximum": 119.24, "gross_charge": 3056.0, "discounted_cash": 2292.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRITICAL CR E&M ADDL 30", "code_information": [{"code": "99292", "type": "CPT"}, {"code": "6169292", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 119.24, "maximum": 119.24, "gross_charge": 3056.0, "discounted_cash": 2292.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRNOP SKULL DEFECT<5 CM DIAM", "code_information": [{"code": "62140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 987.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 987.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 987.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 987.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 987.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRNOP SKULL DEFECT>5 CM DIAM", "code_information": [{"code": "62141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1080.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1080.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1080.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1080.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1080.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT<5 CM DIAM", "code_information": [{"code": "62146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1136.04, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1136.04, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1136.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1136.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1136.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT>5 CM DIAM", "code_information": [{"code": "62147", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1345.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1345.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1345.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1345.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1345.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROM GNOTYP CD55 EXONS 1-10", "code_information": [{"code": "182U", "type": "CPT"}], "standard_charges": [{"minimum": 301.35, "maximum": 301.35, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROMOLYN SODIUM COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7632", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.47, "maximum": 0.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROMOLYN SODIUM NONCOMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7631", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.4, "maximum": 0.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSS-OVER VEIN GRAFT", "code_information": [{"code": "34520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1075.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1075.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1075.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1075.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1075.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROTALIDAE POLY IMMUNE FAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0840", "type": "HCPCS"}], "standard_charges": [{"minimum": 1645.85, "maximum": 1828.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1645.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1828.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1828.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1828.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1828.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRP HI SENSITIVITY", "code_information": [{"code": "86141", "type": "CPT"}, {"code": "4106140", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.03, "gross_charge": 239.0, "discounted_cash": 179.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYO EMBRYO TRANSF CASE RATE", "code_information": [{"code": "S4037", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYO POOR PLASMA", "code_information": [{"code": "P9044", "type": "HCPCS"}, {"code": "4501005", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"gross_charge": 681.0, "discounted_cash": 510.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CRYOABLATE PROSTATE", "code_information": [{"code": "55873", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7263.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7263.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7263.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7263.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7263.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOABLATE RENAL MASS OPEN", "code_information": [{"code": "50250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1270.33, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1270.33, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1270.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1270.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1270.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOCAUTERY OF CERVIX", "code_information": [{"code": "57511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOCRIT QUAL/SEMI QNT/2", "code_information": [{"code": "82595", "type": "CPT"}, {"code": "4102596", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.0, "gross_charge": 146.0, "discounted_cash": 109.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOCRIT QUAL/SEMI QNT/3", "code_information": [{"code": "82595", "type": "CPT"}, {"code": "7252652", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.0, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOFIBRINOGEN", "code_information": [{"code": "82585", "type": "CPT"}, {"code": "7252585", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.73, "gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 43.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION EMBRYO(S)", "code_information": [{"code": "89258", "type": "CPT"}], "standard_charges": [{"minimum": 656.15, "maximum": 656.15, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION OOCYTE(S)", "code_information": [{"code": "89337", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION SPERM", "code_information": [{"code": "89259", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE STEM CELLS", "code_information": [{"code": "38207", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 49.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 49.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 49.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 49.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 49.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE TESTICULAR TISS", "code_information": [{"code": "89335", "type": "CPT"}], "standard_charges": [{"minimum": 49.76, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOSURG ABLATE FA EACH", "code_information": [{"code": "19105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY ANAL LESION(S)", "code_information": [{"code": "46916", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY PENIS LESION(S)", "code_information": [{"code": "54056", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOTHERAPY OF SKIN", "code_information": [{"code": "17340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCIS AB", "code_information": [{"code": "86641", "type": "CPT"}, {"code": "7256173", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.51, "gross_charge": 71.0, "discounted_cash": 53.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 73.51, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCUS NEOFORM AG IA", "code_information": [{"code": "87327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM DFA", "code_information": [{"code": "87272", "type": "CPT"}, {"code": "4106915", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 426.0, "discounted_cash": 319.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM IA", "code_information": [{"code": "87328", "type": "CPT"}, {"code": "4107329", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM IA", "code_information": [{"code": "87328", "type": "CPT"}, {"code": "7257330", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYST ID BODY FLD EX URN", "code_information": [{"code": "89060", "type": "CPT"}, {"code": "4109363", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36.46, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 36.46, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYST ID BODY FLD EX URN", "code_information": [{"code": "89060", "type": "CPT"}, {"code": "4309061", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36.46, "gross_charge": 1443.0, "discounted_cash": 1082.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 36.46, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF LEAK DETECTION", "code_information": [{"code": "78650", "type": "CPT"}, {"code": "5208650", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1305.94, "gross_charge": 2813.0, "discounted_cash": 2109.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 710.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 337.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 337.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 337.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 337.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 337.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT EVALUATION", "code_information": [{"code": "78645", "type": "CPT"}, {"code": "5208645", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 605.22, "gross_charge": 2882.0, "discounted_cash": 2161.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 605.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 590.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 303.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 303.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 303.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 303.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 303.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT REPROGRAM", "code_information": [{"code": "62252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18719.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CSF VENTRICULOGRAPHY", "code_information": [{"code": "78635", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 504.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 504.28, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 292.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 292.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 292.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 292.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 292.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSIT LOWRISK SURG PTS PREOP", "code_information": [{"code": "G8961", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSIT ON PT ANY REAS 30 DAYS", "code_information": [{"code": "G8962", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSIT PERF ON LOW CHD RSK", "code_information": [{"code": "G8965", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSIT PERF SX OR HIGH CHD RSK", "code_information": [{"code": "G8966", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CSTB FULL GENE ANALYSIS", "code_information": [{"code": "232U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB GENE DETC ABNOR ALLELE", "code_information": [{"code": "81188", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB GENE FULL GENE SEQUENCE", "code_information": [{"code": "81189", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81190", "type": "CPT"}], "standard_charges": [{"minimum": 185.2, "maximum": 185.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABD & PELVIS W/CM", "code_information": [{"code": "74177", "type": "CPT"}, {"code": "5014177", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2691.36, "gross_charge": 12816.0, "discounted_cash": 9612.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2691.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1661.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABD & PELVIS W/CM", "code_information": [{"code": "74177", "type": "CPT"}, {"code": "5054177", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2691.36, "gross_charge": 12816.0, "discounted_cash": 9612.0, "setting": "both", "payers_information": 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combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT FUNGI ID MOLD EA", "code_information": [{"code": "87107", "type": "CPT"}, {"code": "4107111", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.63, "gross_charge": 338.0, "discounted_cash": 253.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 52.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT FUNGI ID YEAST EA", "code_information": [{"code": "87106", "type": "CPT"}, {"code": "4107106", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.63, "gross_charge": 368.0, "discounted_cash": 276.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 52.63, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT MYCOBACTERIAL EA ISOL", "code_information": [{"code": "87118", "type": "CPT"}, {"code": "7257119", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.81, "gross_charge": 281.0, "discounted_cash": 210.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 55.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRAFT F/N/HF/G", "code_information": [{"code": "15155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRAFT T/A/L +%", "code_information": [{"code": "15152", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT F/N/HFG ADD", "code_information": [{"code": "15156", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/A/L ADDL", "code_information": [{"code": "15151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/ARM/LEG", "code_information": [{"code": "15150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT STOOL ADD PATH EA/2", "code_information": [{"code": "87046", "type": "CPT"}, {"code": "4107046", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.11, "gross_charge": 349.0, "discounted_cash": 261.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 48.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT STOOL ADD PATH EA/3", "code_information": [{"code": "87046", "type": "CPT"}, {"code": "4107047", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.11, "gross_charge": 165.0, "discounted_cash": 123.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 48.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT STOOL ADD PATH EA/4", "code_information": [{"code": "87046", "type": "CPT"}, {"code": "4107057", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.11, "gross_charge": 349.0, "discounted_cash": 261.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 48.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT STOOL ADD PATH EA/5", "code_information": [{"code": "87046", "type": "CPT"}, {"code": "4107080", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.11, "gross_charge": 349.0, "discounted_cash": 261.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 48.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89250", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89251", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE AEROBIC DEF ID", "code_information": [{"code": "87077", "type": "CPT"}, {"code": "4108707", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 41.21, "gross_charge": 183.0, "discounted_cash": 137.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 41.21, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE AEROBIC QUANT OTHER", "code_information": [{"code": "87071", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.11, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 48.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE AFB", "code_information": [{"code": "87116", "type": "CPT"}, {"code": "4107116", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.12, "gross_charge": 504.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE AFB", "code_information": [{"code": "87116", "type": "CPT"}, {"code": "7050017", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.12, "gross_charge": 256.0, "discounted_cash": 192.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE AFB/2", "code_information": [{"code": "87116", "type": "CPT"}, {"code": "4107134", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.12, "gross_charge": 256.0, "discounted_cash": 192.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 55.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE ANAEROBIC DEF ID/3", "code_information": [{"code": "87076", "type": "CPT"}, {"code": "4107097", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 41.21, "gross_charge": 391.0, "discounted_cash": 293.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 41.21, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE BACT OTH SOURCE", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "7257024", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.91, "gross_charge": 391.0, "discounted_cash": 293.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 43.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE BACT OTH SOURCE/10", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "4107064", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.91, "gross_charge": 391.0, "discounted_cash": 293.25, "setting": "both", "payers_information": [{"payer_name": 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SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 79539.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 79539.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 79539.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 79539.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP ACETABULR TRITAN STRYK CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1506.12, "maximum": 1506.12, "gross_charge": 7172.0, "discounted_cash": 5379.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1506.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP ANATOM DUAL MOBILTY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4011007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1355.76, "maximum": 1355.76, "gross_charge": 6456.0, "discounted_cash": 4842.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1355.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUR FUNCT ASSES; NO CARE PLN", "code_information": [{"code": "G8543", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUR MEDS NOT DOCUMENT", "code_information": [{"code": "G8428", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CURETTE/TREAT CORNEA", "code_information": [{"code": "65435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CURETTE/TREAT CORNEA", "code_information": [{"code": "65436", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CURRENT PERCEP THRESHOLD TST", "code_information": [{"code": "G0255", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM GRAD GLOVE HEAVY", "code_information": [{"code": "S8426", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM GRAD GLOVE MED", "code_information": [{"code": "S8425", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM GRAD SLEEVE HEAVY", "code_information": [{"code": "S8423", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM GRAD SLEEVE MED", "code_information": [{"code": "S8422", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM GRADIENT SLEEV/GLOV", "code_information": [{"code": "S8420", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUSTOM ITEM", "code_information": [{"code": "S1002", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CUTTING RAMUS OPEN W/GRAFT", "code_information": [{"code": "D7943", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV DS ACS BLD ALG 5 YR SCORE", "code_information": [{"code": "415U", "type": "CPT"}], "standard_charges": [{"minimum": 390.75, "maximum": 390.75, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV DS PLASMA ALYS PRTN BMRK", "code_information": [{"code": "19M", "type": "CPT"}], "standard_charges": [{"minimum": 712.4, "maximum": 712.4, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 712.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 712.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV DS QUAN ADVSRM/PLSM LPRTN", "code_information": [{"code": "377U", "type": "CPT"}], "standard_charges": [{"minimum": 47.58, "maximum": 47.58, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYANIDE", "code_information": [{"code": "82600", "type": "CPT"}, {"code": "7252600", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 98.95, "gross_charge": 349.0, "discounted_cash": 261.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 98.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYANOCOBLMN(VIT B12)", "code_information": [{"code": "82607", "type": "CPT"}, {"code": "4102611", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.87, "gross_charge": 564.0, "discounted_cash": 423.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYC CITRULLINATED PEP AB", "code_information": [{"code": "86200", "type": "CPT"}, {"code": "7253596", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.03, "gross_charge": 356.0, "discounted_cash": 267.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYCLOBENZAPRINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303254", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CYCLOBENZAPRINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303254", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CYCLOSPORINE/2", "code_information": [{"code": "80158", "type": "CPT"}, {"code": "7252613", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.09, "gross_charge": 258.0, "discounted_cash": 193.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYMETRA INJECTABLE", "code_information": [{"code": "Q4112", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYP1A2 GENE", "code_information": [{"code": "31U", "type": "CPT"}], "standard_charges": [{"minimum": 174.81, "maximum": 174.81, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2C19 COMMON VARIANTS/2", "code_information": [{"code": "81225", "type": "CPT"}, {"code": "7251231", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1092.34, "gross_charge": 1602.0, "discounted_cash": 1201.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1092.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2C9 COMMON VARIANTS", "code_information": [{"code": "81227", "type": "CPT"}, {"code": "7251227", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 655.36, "gross_charge": 922.0, "discounted_cash": 691.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 655.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 3' GENE DUP/MLT", "code_information": [{"code": "76U", "type": "CPT"}], "standard_charges": [{"minimum": 450.91, "maximum": 450.91, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 5' GENE DUP/MLT", "code_information": [{"code": "75U", "type": "CPT"}], "standard_charges": [{"minimum": 450.91, "maximum": 450.91, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 FULL GENE SEQUENCE", "code_information": [{"code": "71U", "type": "CPT"}], "standard_charges": [{"minimum": 600.0, "maximum": 600.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN COM&SLCT RAR VRNT", "code_information": [{"code": "70U", "type": "CPT"}], "standard_charges": [{"minimum": 676.37, "maximum": 676.37, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 676.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 676.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN CYP2D6-2D7 HYBRID", "code_information": [{"code": "72U", "type": "CPT"}], "standard_charges": [{"minimum": 450.91, "maximum": 450.91, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN CYP2D7-2D6 HYBRID", "code_information": [{"code": "73U", "type": "CPT"}], "standard_charges": [{"minimum": 450.91, "maximum": 450.91, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GENE COM VARIANTS", "code_information": [{"code": "81226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1690.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1690.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP2D6 NONDUPLICATED GENE", "code_information": [{"code": "74U", "type": "CPT"}], "standard_charges": [{"minimum": 450.91, "maximum": 450.91, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP3A4 GENE COMMON VARIANTS", "code_information": [{"code": "81230", "type": "CPT"}], "standard_charges": [{"minimum": 174.81, "maximum": 174.81, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYP3A5 GENE COMMON VARIANTS", "code_information": [{"code": "81231", "type": "CPT"}], "standard_charges": [{"minimum": 174.81, "maximum": 174.81, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYPROHEPTADINE 2MG/5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314878", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CYPROHEPTADINE 2MG/5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314878", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CYPROHEPTADINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303304", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CYPROHEPTADINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303304", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CYSTATIN C", "code_information": [{"code": "82610", "type": "CPT"}, {"code": "7255607", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.42, "gross_charge": 274.0, "discounted_cash": 205.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.42, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO DILAT STRIX/STENOSIS", "code_information": [{"code": "4912279", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12968.0, "discounted_cash": 9726.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CYSTO IMPL 4 OR MORE", "code_information": [{"code": "C9740", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO LASER TX URETERAL CALC", "code_information": [{"code": "S2070", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO RX BALO CATH URTL STRX", "code_information": [{"code": "52284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/ BX(S) W/ BLUE LIGHT", "code_information": [{"code": "C7550", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/PRST8 COMMISSUROTOMY", "code_information": [{"code": "619T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/RENAL STRICTURE TX", "code_information": [{"code": "52343", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/TEMP PROS IMPLANT", "code_information": [{"code": "C9769", "type": "HCPCS"}], "standard_charges": [{"minimum": 6694.0, "maximum": 6694.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO W/UP STRICTURE TX", "code_information": [{"code": "52342", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/URETER STRICTURE TX", "code_information": [{"code": "52341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO, LITHO, VACUUM KIDNEY", "code_information": [{"code": "C9761", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO STRICTURE TX", "code_information": [{"code": "52344", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/LITHOTRIPSY", "code_information": [{"code": "52356", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 24307.0, "estimated_discounted_cash": 55412.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21875.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24307.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/UP STRICTURE", "code_information": [{"code": "52345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOGRAPHY 3VW MIN", "code_information": [{"code": "74430", "type": "CPT"}, {"code": "4904434", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 368.12, "gross_charge": 1406.0, "discounted_cash": 1054.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 295.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 161.83, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOGRAPHY 3VW MIN", "code_information": [{"code": "74430", "type": "CPT"}, {"code": "4914434", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 368.12, "gross_charge": 1645.0, "discounted_cash": 1233.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 345.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 161.83, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 85.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/UP", "code_information": [{"code": "51727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP", "code_information": [{"code": "51728", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP&UP", "code_information": [{"code": "51729", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY", "code_information": [{"code": "52000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15150.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & DUCT CATHETER", "code_information": [{"code": "52010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & REVISE URETHRA", "code_information": [{"code": "52270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & REVISE URETHRA", "code_information": [{"code": "52275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & URETER CATHETER", "code_information": [{"code": "52005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 32892.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND BIOPSY", "code_information": [{"code": "52007", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND RADIOTRACER", "code_information": [{"code": "52250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52214", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52224", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14066.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52234", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 72242.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 20536.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 20161.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9437.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17453.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52277", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17958.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 25652.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 25496.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY CHEMODENERVATION", "code_information": [{"code": "52287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 17152.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY IMPLANT STENT", "code_information": [{"code": "52282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 82686.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY INJECT MATERIAL", "code_information": [{"code": "52327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY PROSTATIC IMP 1-3", "code_information": [{"code": "C9739", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY REMOVAL OF CLOTS", "code_information": [{"code": "52001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY STONE REMOVAL", "code_information": [{"code": "52325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY W/BIOPSY(S)", "code_information": [{"code": "52204", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 16489.11, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO & OR PYELOSCOPE", "code_information": [{"code": "52351", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 60145.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/BIOPSY", "code_information": [{"code": "52354", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 31215.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/CONGEN REPR", "code_information": [{"code": "52400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/EXCISE TUMOR", "code_information": [{"code": "52355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/LITHOTRIPSY", "code_information": [{"code": "52353", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 24307.0, "estimated_discounted_cash": 49000.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7467.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21875.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24307.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/RENAL STRICT", "code_information": [{"code": "52346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/STONE REMOVE", "code_information": [{"code": "52352", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 50692.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO CUT EJACUL DUCT", "code_information": [{"code": "52402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO W/ADDL IMPLANT", "code_information": [{"code": "52442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO W/IMPLANT", "code_information": [{"code": "52441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTURETH BLU LI CYST FL IMG", "code_information": [{"code": "C7554", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTARABINE LIPOSOME INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9098", "type": "HCPCS"}], "standard_charges": [{"minimum": 565.53, "maximum": 628.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 565.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 628.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 628.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 628.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 628.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTO C/V BETHESDA", "code_information": [{"code": "88164", "type": "CPT"}, {"code": "4308164", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.87, "gross_charge": 293.0, "discounted_cash": 219.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 53.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.76, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTO C/V PREP AUTO", "code_information": [{"code": "88175", "type": "CPT"}, {"code": "4308176", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 135.09, "gross_charge": 568.0, "discounted_cash": 426.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 135.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", 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{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH OTHER SOURCE", "code_information": [{"code": "88160", "type": "CPT"}, {"code": "4308160", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.06, "gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 94.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee 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{"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V REDO", "code_information": [{"code": "88165", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 53.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", 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"plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH WASH/BRUSH/SM", "code_information": [{"code": "88104", "type": "CPT"}, {"code": "4308104", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 101.0, "gross_charge": 519.0, "discounted_cash": 389.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPTH CELL ENHANCE TEC", "code_information": [{"code": "88112", "type": "CPT"}, {"code": "4308112", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 195.06, "gross_charge": 384.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 195.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOTOXIC ANTIBODY SCREENING", "code_information": [{"code": "86808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 151.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 151.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.47, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOTOXIC PRA STANDRD", "code_information": [{"code": "86807", "type": "CPT"}, {"code": "7146209", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 201.81, "gross_charge": 1984.0, "discounted_cash": 1488.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 201.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 55.29, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 55.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 55.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 55.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 55.29, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cabg measures grp", "code_information": [{"code": "G8544", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cad meas qual act perform", "code_information": [{"code": "G8498", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW 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payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Clinic Dental Clinic", "code_information": [{"code": "512", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Clinic Psychiatric Clinic", "code_information": [{"code": "513", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE 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[{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Colonoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for colonic stricture, including fluoroscopic guidance, when performed", "code_information": [{"code": "885T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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{"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1652.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1652.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1652.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Complex Motion Imaging Procedure On Both Sides Of Body", "code_information": [{"code": "76102", "type": "CPT"}], "standard_charges": [{"minimum": 244.01, "maximum": 244.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS 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"80502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 236.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 236.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat) Scan, Other", "code_information": [{"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 562.0, "maximum": 626.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 562.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 626.0, 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"facility"}]}, {"description": "Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [OCT]), posterior segment, with interpretation and report, unilateral or bilateral; retina, including OCT angiography", "code_information": [{"code": "92137", "type": "CPT"}], "standard_charges": [{"minimum": 311.4, "maximum": 474.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 427.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 415.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 474.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 474.96, "methodology": "fee schedule"}, {"payer_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Connection of liver allograft to normothermic machine perfusion device, hemostasis control; initial 4 hours of monitoring time, including hourly physiological and laboratory assessments (eg, perfusate temperature, perfusate pH, hemodynamic parameters, bil", "code_information": [{"code": "895T", "type": "CPT"}], "standard_charges": [{"minimum": 12252.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for 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billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1972.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2192.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1905.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2403.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Continuous Ambulatory Peritoneal Dialysis (Capd)- Outpatient Or Home General", "code_information": [{"code": "840", "type": "RC"}], "standard_charges": [{"minimum": 1905.0, "maximum": 2403.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1972.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2192.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1905.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2403.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Continuous Ambulatory Peritoneal Dialysis (Capd)- Outpatient Or Home Home Equipment", "code_information": [{"code": "843", "type": "RC"}], "standard_charges": [{"minimum": 1905.0, "maximum": 2403.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1905.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2403.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Continuous Ambulatory Peritoneal Dialysis (Capd)- Outpatient Or Home Home Supplies", "code_information": [{"code": "842", "type": "RC"}], "standard_charges": [{"minimum": 1905.0, "maximum": 2403.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1905.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2403.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Continuous Ambulatory Peritoneal Dialysis (Capd)- Outpatient Or Home Maintenance/100%", "code_information": [{"code": "844", "type": "RC"}], "standard_charges": [{"minimum": 1905.0, "maximum": 2403.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1905.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2403.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Continuous Ambulatory Peritoneal Dialysis (Capd)- Outpatient Or Home Other", "code_information": [{"code": "849", "type": "RC"}], "standard_charges": [{"minimum": 1905.0, "maximum": 2403.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1905.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2403.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Continuous Ambulatory Peritoneal Dialysis (Capd)- Outpatient Or Home Support Services", "code_information": [{"code": "845", "type": "RC"}], "standard_charges": [{"minimum": 1905.0, "maximum": 2403.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1905.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2403.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Continuous Cycling Peritoneal Dialysis (Ccpd) - Outpatient Or Home Composite Or Other Rate", "code_information": [{"code": "851", "type": "RC"}], "standard_charges": [{"minimum": 1905.0, "maximum": 2403.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1972.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2192.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1905.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2403.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Continuous Cycling Peritoneal Dialysis (Ccpd) - Outpatient Or Home General", "code_information": [{"code": "850", "type": "RC"}], "standard_charges": [{"minimum": 1905.0, "maximum": 2403.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1972.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2192.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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"0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Corticosteroid 10 mg 60 days", "code_information": [{"code": "G8860", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Corticosteroids 10mg 60 days", "code_information": [{"code": "G8859", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Counsel diet phys activity", "code_information": [{"code": "G8780", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Csi any other than pci 2 yr", "code_information": [{"code": "G8964", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Csi per asx pt w/pci 2 yrs", "code_information": [{"code": "G8963", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ct done no rad ds index, nrg", "code_information": [{"code": "G9326", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ct done rad ds index", "code_information": [{"code": "G9327", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ct within 28 days", "code_information": [{"code": "G9349", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy with insertion of temporary device for ischemic remodeling (ie, pressure necrosis) of bladder neck and prostate", "code_information": [{"code": "53865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy, flexible; with removal and replacement of prostatic urethral scaffold", "code_information": [{"code": "942T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cystourethroscopy, flexible; with removal of prostatic urethral scaffold", "code_information": [{"code": "943T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US 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variants and copy number variants, optical genome mapping (OGM)", "code_information": [{"code": "81195", "type": "CPT"}], "standard_charges": [{"minimum": 1263.53, "maximum": 1263.53, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1263.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1263.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "D & C AFTER DELIVERY", "code_information": [{"code": "59160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "D&C OF CERVICAL STUMP", "code_information": [{"code": "57558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC", "code_information": [{"code": "744", "type": "MS-DRG"}], "standard_charges": [{"minimum": 68034.22, "maximum": 85732.29, "estimated_discounted_cash": 227717.9, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 68034.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 85732.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC", "code_information": [{"code": "745", "type": "MS-DRG"}], "standard_charges": [{"minimum": 37767.28, "maximum": 47591.86, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37767.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47591.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "D5 NACL 0.45 1000ML IVF", "code_information": [{"code": "S5010", "type": "HCPCS"}, {"code": "5412290", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 1.89, "maximum": 8.96, "gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "D5W KCL 20 1000ML IVF", "code_information": [{"code": "S5012", "type": "HCPCS"}, {"code": "5412395", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 2.52, "maximum": 5.42, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", 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"code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303320", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DABIGATRAN 75MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303319", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DABIGATRAN 75MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303319", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DACLIZUMAB, PARENTERAL", "drug_information": {"unit": 1.0, "type": 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"standard_charge_dollar": 55.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 55.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 55.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DARBEPOETIN ALFA, ESRD USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0882", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.64, "maximum": 2.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DARBEPOETIN ALFA, NON-ESRD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0881", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.64, "maximum": 2.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DARK FIELD EXAMINATION", "code_information": [{"code": "87164", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 54.79, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DARK FIELD EXAMINATION", "code_information": [{"code": "87166", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 57.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DART CHRONDRAL ARTHREX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8246100", "type": "CDM"}], "standard_charges": [{"minimum": 144.9, "maximum": 144.9, "gross_charge": 690.0, "discounted_cash": 517.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 144.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DARUNAVIR 800MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303463", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 205.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DARUNAVIR 800MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303463", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 205.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DAUNORUBICIN CITRATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9151", "type": "HCPCS"}], "standard_charges": [{"minimum": 51.89, "maximum": 57.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 51.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 57.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DAUNORUBICIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9150", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.53, "maximum": 21.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT BONE 1ST 20 SQ CM/<", "code_information": [{"code": "11044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10736.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 307.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 307.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 307.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 307.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 307.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT BONE EACH ADDL", "code_information": [{"code": "11047", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT ECZ/INFCT SKN EA ADDL", "code_information": [{"code": "11001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT ECZ/INFECTED SKIN<10%", "code_information": [{"code": "11000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT MUSC&/FSCA 1ST 20/<", "code_information": [{"code": "11043", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4009.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT MUSC&/FSCA EA ADDL", "code_information": [{"code": "11046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3077.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT PRMLG LES W/PDT", "code_information": [{"code": "96574", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN ABDOMINAL WALL", "code_information": [{"code": "11005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN XTRNL GENT PER", "code_information": [{"code": "11006", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 688.17, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 688.17, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 688.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 688.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 688.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN XTRNL GENT&PER", "code_information": [{"code": "11004", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 552.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 552.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 552.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 552.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 552.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT SUBQ TIS 1ST 20SQCM/<", "code_information": [{"code": "11042", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2596.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_percentage": 36.9, "possible_amount": 464.98, "count": "1 through 10", "median_amount": 464.98, "methodology": "percent of total billed charges", "10th_percentile": 464.98, "90th_percentile": 464.98}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_percentage": 75.0, "possible_amount": 464.98, "count": "1 through 10", "median_amount": 464.98, "methodology": "percent of total billed charges", "10th_percentile": 464.98, "90th_percentile": 464.98}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT SUBQ TISS EACH ADDL", "code_information": [{"code": "11045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DCLOT CVAD THROMBL AGNT", "code_information": [{"code": "4546593", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1731.0, "discounted_cash": 1298.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DCLOT CVAD THROMBL AGNT", "code_information": [{"code": "4916593", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1930.0, "discounted_cash": 1447.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DCLOT CVAD THROMBL AGNT", "code_information": [{"code": "6296593", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2122.0, "discounted_cash": 1591.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DCLOT CVAD THROMBL AGNT", "code_information": [{"code": "6926593", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1731.0, "discounted_cash": 1298.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DCMPRN PX PERQ 1/MLT LUMBAR", "code_information": [{"code": "62287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEB BONE 20 CM2 W/DRUG DEV", "code_information": [{"code": "C7500", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEB SKIN BONE AT FX SITE", "code_information": [{"code": "11012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRD INFCT SKN UP TO 10", "code_information": [{"code": "6900134", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRD INFCT SKN UP TO 10", "code_information": [{"code": "6900134", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRID SUBQ 1ST 20 SQ CM OR <", "code_information": [{"code": "6900040", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRID SUBQ 1ST 20 SQ CM OR <", "code_information": [{"code": "6900040", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE BONE 20SQ CM/<", "code_information": [{"code": "6900044", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5096.0, "discounted_cash": 3822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE BONE 20SQ CM/<", "code_information": [{"code": "6900044", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 5096.0, "discounted_cash": 3822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE BONE EA ADD 20SQ", "code_information": [{"code": "6900045", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5146.0, "discounted_cash": 3859.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE BONE EA ADD 20SQ", "code_information": [{"code": "6900045", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 5146.0, "discounted_cash": 3859.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE MSCL/FSCA 20SQCM", "code_information": [{"code": "6900042", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE MSCL/FSCA 20SQCM", "code_information": [{"code": "6900042", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE MSCL/FSCA EA ADD", "code_information": [{"code": "6900043", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2911.0, "discounted_cash": 2183.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE MSCL/FSCA EA ADD", "code_information": [{"code": "6900043", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2911.0, "discounted_cash": 2183.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 1-5", "code_information": [{"code": "6900036", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 1-5", "code_information": [{"code": "6900036", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 1-5", "code_information": [{"code": "11720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5352.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 6 OR MORE", "code_information": [{"code": "6900037", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 6 OR MORE", "code_information": [{"code": "6900037", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 6 OR MORE", "code_information": [{"code": "11721", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2816.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SKIN AT FX SITE", "code_information": [{"code": "11010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SKIN MUSC AT FX SITE", "code_information": [{"code": "11011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SUBQ EA ADD 20SQ", "code_information": [{"code": "6900041", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2204.0, "discounted_cash": 1653.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE SUBQ EA ADD 20SQ", "code_information": [{"code": "6900041", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2204.0, "discounted_cash": 1653.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DECALCIFICATION", "code_information": [{"code": "88311", "type": "CPT"}, {"code": "4308311", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.73, "gross_charge": 417.0, "discounted_cash": 312.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECLOT VASCULAR DEVICE", "code_information": [{"code": "36593", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1489.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS DISC RF LUMBAR", "code_information": [{"code": "S2348", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS EYE SOCKET", "code_information": [{"code": "61330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26037", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 561.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 561.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 561.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 561.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 561.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 1 SPACE", "code_information": [{"code": "25020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 1 SPACE", "code_information": [{"code": "25023", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 2 SPACES", "code_information": [{"code": "25024", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 2 SPACES", "code_information": [{"code": "25025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS OPTIC NERVE", "code_information": [{"code": "67570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SMALL BOWEL", "code_information": [{"code": "44021", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 889.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 889.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 889.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 889.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 889.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD LMBR", "code_information": [{"code": "63056", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1436.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1436.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1436.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1436.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1436.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD THRC", "code_information": [{"code": "63055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1547.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1547.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1547.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1547.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1547.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD THRC", "code_information": [{"code": "63064", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1698.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1698.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1698.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1698.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1698.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINE CORD ADD-ON", "code_information": [{"code": "63057", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 322.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 322.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 322.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 322.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 322.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINE CORD ADD-ON", "code_information": [{"code": "63066", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 197.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 197.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 197.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 197.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 197.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF FOREARM", "code_information": [{"code": "24495", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27892", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27893", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27894", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27497", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27498", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF TIBIA NERVE", "code_information": [{"code": "28035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSIVE CRANIOTOMY", "code_information": [{"code": "61322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2155.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2155.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2155.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2155.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2155.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSIVE LOBECTOMY", "code_information": [{"code": "61323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2201.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2201.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2201.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2201.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2201.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOR OR SUBMERG ERUPT TOOTH", "code_information": [{"code": "D3921", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEEP MUSCLE BIOPSY", "code_information": [{"code": "20205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEGARELIX INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9155", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.01, "maximum": 4.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [{"code": "56", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9065.51, "maximum": 97196.18, "estimated_discounted_cash": 72718.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15921.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11154.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 35112.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21922.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16753.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23067.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36946.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11737.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24358.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17690.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39014.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12394.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17690.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12394.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39014.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24358.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17690.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39014.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12394.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24358.8, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9065.51, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16363.32, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 33352.84, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10650.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 77131.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 97196.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [{"code": "57", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4315.54, "maximum": 54206.61, "estimated_discounted_cash": 168826.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21959.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14910.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10005.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36294.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 38190.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15689.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10527.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23106.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16567.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11116.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 40328.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24399.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40328.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24399.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16567.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11116.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40328.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11116.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16567.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24399.38, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 23274.98, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11702.06, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6778.59, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4315.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43016.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 54206.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEHYDROEPIANDRST SULFATE", "code_information": [{"code": "82627", "type": "CPT"}, {"code": "7252631", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 113.41, "gross_charge": 631.0, "discounted_cash": 473.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 113.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.07, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEHYDROEPIANDRSTRONE", "code_information": [{"code": "82626", "type": "CPT"}, {"code": "7252632", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 128.88, "gross_charge": 518.0, "discounted_cash": 388.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 128.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP ARMS/LEGS", "code_information": [{"code": "15610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP EYE/NOS/EAR/LIP", "code_information": [{"code": "15630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP F/C/C/N/AX/G/H/F", "code_information": [{"code": "15620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP TRUNK", "code_information": [{"code": "15600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELIVER PLACENTA", "code_information": [{"code": "59414", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELIVERY COMP IMRT", "code_information": [{"code": "G6016", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 975.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 878.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 975.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 975.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 975.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 975.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELIVERY COMPLEX", "code_information": [{"code": "3101212", "type": "CDM"}, {"code": "722", "type": "RC"}], "standard_charges": [{"gross_charge": 8062.0, "discounted_cash": 6046.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DELIVERY SIMPLE", "code_information": [{"code": "3101210", "type": "CDM"}, {"code": "722", "type": "RC"}], "standard_charges": [{"gross_charge": 8297.0, "discounted_cash": 6222.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DELIVERY/SET UP/DISPENSING", "code_information": [{"code": "A9901", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DELUXE ITEM", "code_information": [{"code": "S1001", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEMECLOCYCLINE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303515", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 18.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DEMECLOCYCLINE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303515", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 18.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DEMO-SMOKING CESSATION COUN", "code_information": [{"code": "G9016", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEMONSTRATE USE HOME INR MON", "code_information": [{"code": "G0248", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.78, "maximum": 180.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 162.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 157.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENERVATION OF HIP JOINT", "code_information": [{"code": "27035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENGUE FEVER AB", "code_information": [{"code": "86790", "type": "CPT"}, {"code": "7256717", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.7, "gross_charge": 223.0, "discounted_cash": 167.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENGUE FEVER AB/2", "code_information": [{"code": "86790", "type": "CPT"}, {"code": "7256720", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.7, "gross_charge": 223.0, "discounted_cash": 167.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENGUE VACC QUAD 2 DOSE SUBQ", "code_information": [{"code": "90584", "type": "CPT"}], "standard_charges": [{"minimum": 71.28, "maximum": 79.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENGUE VACC QUAD 3 DOSE SUBQ", "code_information": [{"code": "90587", "type": "CPT"}], "standard_charges": [{"minimum": 71.28, "maximum": 79.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENOSUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0897", "type": "HCPCS"}, {"code": "5319802", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 26.44, "maximum": 29.38, "gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENOSUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0897", "type": "HCPCS"}, {"code": "5319802", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 26.44, "maximum": 29.38, "gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENT SUTUR RECENT WND TO 5CM", "code_information": [{"code": "D7910", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [{"code": "158", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30207.18, "maximum": 38065.12, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30207.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38065.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [{"code": "157", "type": "MS-DRG"}], "standard_charges": [{"minimum": 57001.19, "maximum": 71829.2, "estimated_discounted_cash": 66813.68, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 57001.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 71829.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITHOUT CC/MCC", "code_information": [{"code": "159", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23523.62, "maximum": 29642.93, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23523.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29642.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL BITEWING SINGLE IMAGE", "code_information": [{"code": "D0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL BITEWINGS TWO IMAGES", "code_information": [{"code": "D0272", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL CORONOIDECTOMY", "code_information": [{"code": "D7991", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL SKIN GRAFT", "code_information": [{"code": "D7920", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL SUTURE WOUND TO 5 CM", "code_information": [{"code": "D7911", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEP SCR NOT DOC, RNG", "code_information": [{"code": "G8432", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEPRESSION SCREEN ANNUAL", "code_information": [{"code": "G0444", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEPRESSIVE NEUROSES", "code_information": [{"code": "881", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1421.0, "maximum": 39366.32, "estimated_discounted_cash": 94335.73, "setting": "inpatient", "payers_information": [{"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "standard_charge_dollar": 1421.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31239.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39366.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT F/N/HF/G ADD", "code_information": [{"code": "15136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT FACE/NCK/HF/G", "code_information": [{"code": "15135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT T/A/L ADD-ON", "code_information": [{"code": "15131", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT TRNK/ARM/LEG", "code_information": [{"code": "15130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMA-FAT-FASCIA GRAFT", "code_information": [{"code": "15770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMABRASION OTHER THAN FACE", "code_information": [{"code": "15782", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMABRASION SEGMENTAL FACE", "code_information": [{"code": "15781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMABRASION SUPRFL ANY SITE", "code_information": [{"code": "15783", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMABRASION TOTAL FACE", "code_information": [{"code": "15780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMACELL, AWM, POROUS SQ CM", "code_information": [{"code": "Q4122", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMAGRAFT", "code_information": [{"code": "Q4106", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMAL FILLER INJECTION(S)", "code_information": [{"code": "G0429", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DES L/S FACET JNT ADDL", "code_information": [{"code": "4914636", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3826.0, "discounted_cash": 2869.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DESIGN CUSTOM BREAST IMPLANT", "code_information": [{"code": "19396", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESIPRAMINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303568", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DESIPRAMINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303568", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DESIPRAMINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303569", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DESIPRAMINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303569", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DESMOPRESSIN .2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303586", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DESMOPRESSIN .2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303586", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DESMOPRESSIN PER 1MCG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2597", "type": "HCPCS"}, {"code": "5319819", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.17, "maximum": 3.52, "gross_charge": 86.0, "discounted_cash": 64.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESMOPRESSIN PER 1MCG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2597", "type": "HCPCS"}, {"code": "5319819", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.17, "maximum": 3.52, "gross_charge": 86.0, "discounted_cash": 64.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESOXYCORTICOSTERONE", "code_information": [{"code": "82633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 157.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 157.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEST C/THO FACT JNT ADDL", "code_information": [{"code": "4914634", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2849.0, "discounted_cash": 2136.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DEST CERV/THO FACET JNT", "code_information": [{"code": "4914633", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8146.0, "discounted_cash": 6109.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DESTROY C/TH FACET JNT ADDL", "code_information": [{"code": "64634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY CERV/THOR FACET JNT", "code_information": [{"code": "64633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY INTERNAL HEMORRHOIDS", "code_information": [{"code": "46930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY L/S FACET JNT ADDL", "code_information": [{"code": "64636", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY LUMB/SAC FACET JNT", "code_information": [{"code": "64635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY NERVE FACE MUSCLE", "code_information": [{"code": "64612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY NERVE OF EYE MUSCLE", "code_information": [{"code": "67345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 87.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 87.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 87.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 87.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 87.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY PREMAL LESIONS 15/>", "code_information": [{"code": "17004", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 87.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 87.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 87.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 87.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 87.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY VAG LESIONS COMPLEX", "code_information": [{"code": "57065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY VAG LESIONS SIMPLE", "code_information": [{"code": "57061", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY VULVA LESION/S COMPL", "code_information": [{"code": "56515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY VULVA LESIONS SIM", "code_information": [{"code": "56501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCT B9 LESION 1-14", "code_information": [{"code": "17110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10440.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCT LESION 1-14", "code_information": [{"code": "6907111", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DESTRUCT LESION 1-14", "code_information": [{"code": "6907111", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DESTRUCT LESION 15 OR MORE", "code_information": [{"code": "17111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LES 2-14", "code_information": [{"code": "17003", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LESION", "code_information": [{"code": "17000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 124.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 124.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 124.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 124.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 124.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46924", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 23828.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION RECTAL TUMOR", "code_information": [{"code": "45190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DETECT AGENT NOS DNA DIR", "code_information": [{"code": "87797", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 102.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 102.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECT AGNT MULT DNA DIREC", "code_information": [{"code": "87800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 204.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 204.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 56.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 56.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 56.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 56.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 56.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 43.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETERMINE REFRACTIVE STATE", "code_information": [{"code": "92015", "type": "CPT"}], "standard_charges": [{"minimum": 38.3, "maximum": 49.64, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 39.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 38.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEV CAPIO SUTURE OPEN", "code_information": [{"code": "C2631", "type": "HCPCS"}, {"code": "8240916", "type": "CDM"}], "standard_charges": [{"minimum": 813.75, "maximum": 813.75, "gross_charge": 3875.0, "discounted_cash": 2906.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 813.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEV CLOSR VASC IMP/INSRT", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "8240133", "type": "CDM"}], "standard_charges": [{"minimum": 305.76, "maximum": 305.76, "gross_charge": 1456.0, "discounted_cash": 1092.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 305.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEV INTERROG REMOTE 1/2/MLT", "code_information": [{"code": "93295", "type": "CPT"}], "standard_charges": [{"minimum": 88.96, "maximum": 101.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 91.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 88.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 101.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 101.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 101.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEV REP URINARY W/SLING", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "8240135", "type": "CDM"}], "standard_charges": [{"minimum": 9474.36, "maximum": 9474.36, "gross_charge": 45116.0, "discounted_cash": 33837.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 9474.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEV RETRIEVAL INSERTABLE", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "8240139", "type": "CDM"}], "standard_charges": [{"minimum": 381.99, "maximum": 381.99, "gross_charge": 1819.0, "discounted_cash": 1364.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 381.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVEL TST PHYS/QHP 1ST HR", "code_information": [{"code": "96112", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVELOPMENTAL SCREEN W/SCORE", "code_information": [{"code": "96110", "type": "CPT"}], "standard_charges": [{"minimum": 10.73, "maximum": 24.39, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVISE BOWEL POUCH", "code_information": [{"code": "44316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1273.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1273.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1273.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1273.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1273.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEVLOPMENT TEST INTERPT&REP", "code_information": [{"code": "G0451", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXA APPENDICULAR SKELTN", "code_information": [{"code": "77081", "type": "CPT"}, {"code": "5016076", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 115.5, "gross_charge": 550.0, "discounted_cash": 412.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 96.59, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 39.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 39.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 39.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 39.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 39.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXA AXIAL SKELETON", "code_information": [{"code": "77080", "type": "CPT"}, {"code": "5016080", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 637.77, "gross_charge": 3037.0, "discounted_cash": 2277.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 637.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 239.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXA AXIAL SKELETON", "code_information": [{"code": "77080", "type": "CPT"}, {"code": "5206050", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 473.76, "gross_charge": 2256.0, "discounted_cash": 1692.0, "setting": "both", "payers_information": 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{"description": "DGTZ GLS MCRSCP SLD LEVEL IV", "code_information": [{"code": "753T", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LEVEL V", "code_information": [{"code": "754T", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": 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"code_information": [{"code": "4616907", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 18247.0, "discounted_cash": 13685.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DIA-CIR APLAS+IMG+S&I", "code_information": [{"code": "4916907", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1141.0, "discounted_cash": 855.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIA-CIR STENT+IMG+S&I", "code_information": [{"code": "4616908", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 58538.0, "discounted_cash": 43903.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIA-CIR STENT+IMG+S&I", "code_information": [{"code": "4916908", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23281.0, "discounted_cash": 17460.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIA-CIR THRO+IMG+S&I", "code_information": [{"code": "4916904", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5934.0, "discounted_cash": 4450.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIA-CIR THRO+PLST+IMG+S&I", "code_information": [{"code": "4616905", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 58538.0, "discounted_cash": 43903.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIA-CIR THRO+PLST+IMG+S&I", "code_information": [{"code": "4916905", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6448.0, "discounted_cash": 4836.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIA-CIR THRO+STN+IMG+S&I", "code_information": [{"code": "4916906", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 100091.0, "discounted_cash": 75068.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DIAB SLFMGMT GRP 30 MIN", "code_information": [{"code": "G0109", "type": "HCPCS"}, {"code": "6700109", "type": "CDM"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 30.43, "maximum": 43.26, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 43.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 31.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 34.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 34.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 34.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAB SLFMGMT IND 30 MIN", "code_information": [{"code": "G0108", "type": "HCPCS"}, {"code": "3530108", "type": "CDM"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 53.55, "maximum": 126.31, "gross_charge": 255.0, "discounted_cash": 191.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 53.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 113.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 110.45, "methodology": "fee 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37496.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH MCC", "code_information": [{"code": "637", "type": "MS-DRG"}], "standard_charges": [{"minimum": 47701.31, "maximum": 60110.09, "estimated_discounted_cash": 71473.12, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47701.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 60110.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES WITHOUT CC/MCC", "code_information": [{"code": "639", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5620.12, "maximum": 47438.25, "estimated_discounted_cash": 44137.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8828.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 28911.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6454.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42693.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9289.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6791.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 44923.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30421.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7172.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 47438.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9809.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32124.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9809.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7172.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32124.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 47438.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 47438.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32124.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7172.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9809.73, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 45621.09, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5620.12, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13221.9, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 32262.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20625.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25990.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9140", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9141", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9455", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9460", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9465", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAG BRONCHOSCOPE/CATHETER", "code_information": [{"code": "31643", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAG LAPARO SEPARATE PROC", "code_information": [{"code": "49320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 25917.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY", "code_information": [{"code": "46601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY & BIOPSY", "code_information": [{"code": "46607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY SPX", "code_information": [{"code": "46600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC COLONOSCOPY", "code_information": [{"code": "45378", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7965.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC LARYNGOSCOPY", "code_information": [{"code": "31505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC LARYNGOSCOPY", "code_information": [{"code": "31575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC SIGMOIDOSCOPY", "code_information": [{"code": "45330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5141.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 88.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 88.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 88.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 88.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 88.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAL-CIRC BAL-PLASTY+S&I", "code_information": [{"code": "4916902", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2868.0, "discounted_cash": 2151.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIAL-CIRC STNT+PLSTY+S&I", "code_information": [{"code": "4916903", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 58538.0, "discounted_cash": 43903.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALYSIS ACCESS SYSTEM", "code_information": [{"code": "C1881", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIALYSIS ACU KIDNEY NO ESRD", "code_information": [{"code": "G0491", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.99, "maximum": 11.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS CIRCUIT EMBOLJ", "code_information": [{"code": "36909", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIALYSIS REPEATED EVAL", "code_information": [{"code": "90947", "type": "CPT"}], "standard_charges": [{"minimum": 116.81, "maximum": 278.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 116.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 250.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 243.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 278.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 278.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 278.32, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 116.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 116.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 116.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 116.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS TRAINING INCOMPL", "code_information": [{"code": "90993", "type": "CPT"}], "standard_charges": [{"minimum": 146.21, "maximum": 167.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 150.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 146.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 167.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 167.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 167.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAPER SERV REUSABLE DIAPER", "code_information": [{"code": "T4538", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAPHRAGM", "code_information": [{"code": "A4266", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.76, "maximum": 30.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAS BP > OR = 90", "code_information": [{"code": "G8755", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIAS BP LESS 90", "code_information": [{"code": "G8754", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIATHERMY EG MICROWAVE", "code_information": [{"code": "97024", "type": "CPT"}], "standard_charges": [{"minimum": 4.39, "maximum": 16.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZEPAM 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303716", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIAZEPAM 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303716", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIAZEPAM 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303708", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIAZEPAM 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303708", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIAZEPAM 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303712", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIAZEPAM 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303712", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIAZOXIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1730", "type": "HCPCS"}], "standard_charges": [{"minimum": 100.66, "maximum": 111.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 100.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 111.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 111.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 111.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 111.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIBUCAINE NUMBER", "code_information": [{"code": "82638", "type": "CPT"}, {"code": "7252638", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.45, "gross_charge": 265.0, "discounted_cash": 198.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 62.45, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.25, "methodology": 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0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DICYCLOMINE 10MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314950", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 362.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DICYCLOMINE 10MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314950", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 362.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DICYCLOMINE PER 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314953", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, 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{"description": "DIGIT NERVE SURGERY ADD-ON", "code_information": [{"code": "64778", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": 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"EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303952", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIGOXIN IMM FB PER VL IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1162", "type": "HCPCS"}, {"code": "5320031", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 4651.41, "maximum": 5168.23, "gross_charge": 25106.0, "discounted_cash": 18829.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4651.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5168.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5168.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5168.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5168.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGOXIN IMM FB PER VL IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1162", "type": "HCPCS"}, {"code": "5320031", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4651.41, "maximum": 5168.23, "gross_charge": 25106.0, "discounted_cash": 18829.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4651.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5168.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5168.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5168.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5168.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGOXIN TOTAL", "code_information": [{"code": "80162", "type": "CPT"}, {"code": "4102643", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.71, "gross_charge": 191.0, "discounted_cash": 143.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIHYDROTESTOSTERONE", "code_information": [{"code": "82642", "type": "CPT"}, {"code": "7252641", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 29.28, "maximum": 29.28, "gross_charge": 187.0, "discounted_cash": 140.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIL BLLN ESOPH WR", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "8174028", "type": "CDM"}], "standard_charges": [{"minimum": 1279.74, "maximum": 1279.74, "gross_charge": 6094.0, "discounted_cash": 4570.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIL BLN ESOPH/PYLORIC", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "8246180", "type": "CDM"}], "standard_charges": [{"minimum": 1279.74, "maximum": 1279.74, "gross_charge": 6094.0, "discounted_cash": 4570.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIL BLN ESP/PYL/COL BIL", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "8174027", "type": "CDM"}], "standard_charges": [{"minimum": 1279.74, "maximum": 1279.74, "gross_charge": 6094.0, "discounted_cash": 4570.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIL BLN ESPH/PYL/COL WG", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "8174026", "type": "CDM"}], "standard_charges": [{"minimum": 1279.74, "maximum": 1279.74, "gross_charge": 6094.0, "discounted_cash": 4570.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIL BLN WR GUIDE 3STAGE", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "8174034", "type": "CDM"}], "standard_charges": [{"minimum": 1279.74, "maximum": 1279.74, "gross_charge": 6094.0, "discounted_cash": 4570.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIL MACULA/FUNDUS EXAM/W DOC", "code_information": [{"code": "G8397", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DILAT BILE DUCT EA", "code_information": [{"code": "4917542", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6145.0, "discounted_cash": 4608.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA DIFF TER", "code_information": [{"code": "61642", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 402.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 402.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 402.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 402.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 402.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA VSL SM TER", "code_information": [{"code": "61641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 201.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 201.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 201.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 201.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 201.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILAT NEPHRO/URETR/URETH", "code_information": [{"code": "74485", "type": "CPT"}, {"code": "4914486", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1792.99, "gross_charge": 5591.0, "discounted_cash": 4193.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1174.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 380.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 153.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 153.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 153.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 153.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 153.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1792.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1792.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILAT XIST TRC NDURLOGIC PROC", "code_information": [{"code": "4910436", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6225.0, "discounted_cash": 4668.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILAT XIST TRC NEW ACCESS RCS", "code_information": [{"code": "4910437", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6225.0, "discounted_cash": 4668.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILAT XST TRC NDURLGC PX", "code_information": [{"code": "50436", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILAT XST TRC NEW ACCESS RCS", "code_information": [{"code": "50437", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE BILIARY DUCT/AMPULLA", "code_information": [{"code": "47542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE ESOPHAGUS", "code_information": [{"code": "43453", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 261.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 261.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 261.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 261.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 261.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE ESOPHAGUS 1/MULT PASS", "code_information": [{"code": "43450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5196.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 261.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 261.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 261.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 261.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 261.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE IC VASOSPASM INIT", "code_information": [{"code": "61640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 572.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 572.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 572.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 572.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 572.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE TEAR DUCT OPENING", "code_information": [{"code": "68801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17320.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 67.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 67.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 67.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 67.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 67.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 71.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 71.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 71.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 71.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 71.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION AND CURETTAGE", "code_information": [{"code": "58120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9769.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF ANAL SPHINCTER", "code_information": [{"code": "45905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 21063.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF CERVICAL CANAL", "code_information": [{"code": "57800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF RECTAL NARROWING", "code_information": [{"code": "45910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 51.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 51.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 51.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 51.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 51.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF VAGINA", "code_information": [{"code": "57400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILTIAZEM 120MG XR24 CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304043", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 120MG XR24 CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304043", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 180MG XR24 CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304044", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 180MG XR24 CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304044", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 240MG XR24 CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304045", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 240MG XR24 CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304045", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 300MG XR24 CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304046", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 300MG XR24 CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304046", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304033", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304033", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304037", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304037", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 60MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304042", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 60MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304042", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 90MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304038", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 90MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304038", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 90MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304040", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 90MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304040", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM PER 0.5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1163", "type": "HCPCS"}, {"code": "5320057", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.32, "discounted_cash": 0.24, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILTIAZEM PER 0.5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1163", "type": "HCPCS"}, {"code": "5320057", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.32, "discounted_cash": 0.24, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILTIAZEM PER 0.5MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1163", "type": "HCPCS"}, {"code": "5320069", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.47, "discounted_cash": 0.35, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILTIAZEM PER 0.5MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1163", "type": "HCPCS"}, {"code": "5320069", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.47, "discounted_cash": 0.35, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIMETHYL SULFOX 50% 50ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1212", "type": "HCPCS"}, {"code": "5339049", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 673.97, "maximum": 748.85, "gross_charge": 3873.0, "discounted_cash": 2904.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 673.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 748.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 748.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 748.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 748.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIMETHYL SULFOX 50% 50ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1212", "type": "HCPCS"}, {"code": "5339049", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 673.97, "maximum": 748.85, "gross_charge": 3873.0, "discounted_cash": 2904.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 673.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 748.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 748.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 748.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 748.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304091", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304091", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE HCL 50MG", "code_information": [{"code": "Q0163", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIPHENOX/ATROP 2.5 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304098", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHENOX/ATROP 2.5 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304098", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHENOXYLATE/ATRP 60LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315020", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHENOXYLATE/ATRP 60LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315020", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHTHERIA ANTITOXIN", "code_information": [{"code": "90296", "type": "CPT"}], "standard_charges": [{"minimum": 2474.32, "maximum": 2749.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2474.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2749.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2749.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2749.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2749.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPTHERIA AB", "code_information": [{"code": "86648", "type": "CPT"}, {"code": "7256590", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 77.56, "gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 77.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPYRDAML/ASA200/25 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304123", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPYRDAML/ASA200/25 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304123", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPYRIDAMOLE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304114", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPYRIDAMOLE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304114", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIRECT REFER HOSPITAL OBSERV", "code_information": [{"code": "G0379", "type": "HCPCS"}], "standard_charges": [{"estimated_discounted_cash": 696.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION SHO SEC CLSR", "code_information": [{"code": "23921", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION SHOULDER", "code_information": [{"code": "23920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1062.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1062.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1062.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1062.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1062.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISCOGRAPHY CERV/THOR", "code_information": [{"code": "72285", "type": "CPT"}, {"code": "4912285", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1754.39, "gross_charge": 2166.0, "discounted_cash": 1624.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 454.86, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 288.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 288.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 288.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 288.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 288.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISCOGRAPHY LUMBAR", "code_information": [{"code": "72295", "type": "CPT"}, {"code": "4912290", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 3024.63, "gross_charge": 14403.0, "discounted_cash": 10802.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3024.63, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 263.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 263.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 263.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 263.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 263.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISE EVAL SLP DO BRTH FLX DX", "code_information": [{"code": "42975", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISEASE MANAGEMENT PROGRAM", "code_information": [{"code": "S0315", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISEASE MGMT PER DIEM", "code_information": [{"code": "S0317", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISKECTOMY, ANTERIOR, WITH D", "code_information": [{"code": "S2350", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISKECTOMY, ANTERIOR, WITH D", "code_information": [{"code": "S2351", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISOPYRAMIDE", "code_information": [{"code": "80375", "type": "CPT"}, {"code": "7252498", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 436.0, "discounted_cash": 327.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISOPYRAMIDE 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304143", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DISOPYRAMIDE 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304143", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DISOPYRAMIDE 100MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 66570.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19950.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 35648.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 66570.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25383.98, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 22262.62, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 58353.77, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9338.17, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13581.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 36336.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45788.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [{"code": "444", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11752.94, "maximum": 72098.2, "estimated_discounted_cash": 65349.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17259.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 64887.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25736.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37971.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 39954.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 27080.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 68276.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18160.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 42190.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 72098.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28596.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19177.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 72098.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 42190.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19177.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28596.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 72098.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19177.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28596.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 42190.59, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 27248.72, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 18095.8, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 51250.35, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11752.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55477.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 69908.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC", "code_information": [{"code": "446", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6915.57, "maximum": 54783.27, "estimated_discounted_cash": 56643.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29747.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15540.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18924.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 49304.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31301.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16352.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19912.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51879.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 54783.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17267.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33053.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21026.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21026.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33053.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 54783.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17267.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21026.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17267.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 54783.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33053.64, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8815.03, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16305.92, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6915.57, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 27343.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27468.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34613.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISP FEE CONTRALATERAL BINAU", "code_information": [{"code": "V5240", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISP FEE CONTRALATERAL MONAU", "code_information": [{"code": "V5200", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISP FEE INHAL DRUGS/30 DAYS", "code_information": [{"code": "Q0513", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISP FEE INHAL DRUGS/90 DAYS", "code_information": [{"code": "Q0514", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPENS FEE IMMUNOSUPRESSIVE", "code_information": [{"code": "Q0510", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPENSE FEE INITIAL 30 DAY", "code_information": [{"code": "G0333", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPENSING FEE BINAURAL", "code_information": [{"code": "V5160", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPENSING FEE, MONAURAL", "code_information": [{"code": "V5241", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOS CONT LENS", "code_information": [{"code": "S0500", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOSABLE LINER/SHIELD/PAD", "code_information": [{"code": "T4535", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOSABLE UNDERPADS", "code_information": [{"code": "A4554", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISSECT BRAIN W/SCOPE", "code_information": [{"code": "62161", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1434.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1434.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1434.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1434.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1434.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISSOLVE CLOT HEART VESSEL", "code_information": [{"code": "92977", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 449.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 238.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 404.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 392.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 238.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 238.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 238.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 238.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIST REVAS LIGATION HEMO", "code_information": [{"code": "36838", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1206.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1206.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1206.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1206.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1206.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 125MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304190", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVALPROX NA 125MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304190", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVALPROX NA 125MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312260", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVALPROX NA 125MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312260", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVALPROX NA 250MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304191", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVALPROX NA 250MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304191", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVALPROX NA 250MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304196", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVALPROX NA 250MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304196", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVALPROX NA 500MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304193", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVALPROX NA 500MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304193", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVALPROX NA 500MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304195", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVALPROX NA 500MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304195", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVISION OF FALLOPIAN TUBE", "code_information": [{"code": "58600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIVISION OF FALLOPIAN TUBE", "code_information": [{"code": "58605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DLYD PLMT XTN PROSTH 1ST VSL", "code_information": [{"code": "34710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DLYD PLMT XTN PROSTH EA ADDL", "code_information": [{"code": "34711", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DMD DUP/DELET ANALYSIS", "code_information": [{"code": "81161", "type": "CPT"}, {"code": "7251161", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 525.38, "gross_charge": 9596.0, "discounted_cash": 7197.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 525.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4035", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4087", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.76, "maximum": 54.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 49.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 47.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 54.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 54.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 54.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4088", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.76, "maximum": 54.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 49.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 47.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 54.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 54.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 54.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4149", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.7, "maximum": 1.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4150", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.73, "maximum": 0.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4152", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4153", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.5, "maximum": 2.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4154", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.87, "maximum": 0.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4155", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.47, "maximum": 1.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4164", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.77, "maximum": 38.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4168", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.27, "maximum": 55.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 50.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 55.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 55.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 55.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 55.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4176", "type": "HCPCS"}], "standard_charges": [{"minimum": 97.25, "maximum": 108.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 97.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 108.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 108.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 108.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 108.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4178", "type": "HCPCS"}], "standard_charges": [{"minimum": 116.98, "maximum": 129.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 116.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 129.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 129.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 129.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 129.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4180", "type": "HCPCS"}], "standard_charges": [{"minimum": 49.8, "maximum": 55.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 55.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 55.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 55.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 55.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B5100", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.22, "maximum": 0.24, "setting": "outpatient", "payers_information": 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4360", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4363", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No 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"standard_charges": [{"minimum": 43.16, "maximum": 49.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 44.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5504", "type": "HCPCS"}], "standard_charges": 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 35.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 40.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5513", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.07, "maximum": 60.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 54.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 53.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 60.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 60.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 60.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A5514", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.07, "maximum": 60.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 54.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 53.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 60.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 60.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 60.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6021", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", 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"billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6407", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6410", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6411", "type": "HCPCS"}], 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 158.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 154.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 176.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 176.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0480", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0481", "type": "HCPCS"}], "standard_charges": [{"minimum": 16803.95, "maximum": 19216.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW 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"standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0485", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0486", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0490", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0491", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0492", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0493", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0494", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0495", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0496", "type": "HCPCS"}], "standard_charges": [{"minimum": 1733.74, "maximum": 1982.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1784.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1733.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1982.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1982.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1982.66, "methodology": 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total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0502", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0503", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0504", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q0506", "type": "HCPCS"}], "standard_charges": [{"minimum": 987.76, "maximum": 1129.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1016.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 987.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1129.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1129.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1129.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4001", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4002", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4003", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4004", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4005", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4006", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4007", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4008", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4009", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4010", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.56, "maximum": 31.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 28.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 31.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 31.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 31.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4011", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4012", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4013", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4014", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4015", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4016", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4017", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4018", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4019", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4020", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4021", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4024", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4025", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4026", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4027", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", 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"standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4030", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4031", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4032", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4033", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4034", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4035", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4036", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"Q4038", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.49, "maximum": 57.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 51.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4039", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4040", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4041", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4042", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4043", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4044", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4045", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4046", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.43, "maximum": 30.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4047", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4048", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4049", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2020", "type": "HCPCS"}], "standard_charges": [{"minimum": 83.49, "maximum": 95.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 85.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 83.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 95.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 95.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER 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"plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DNA/RNA AMPLIFIED PROBE", "code_information": [{"code": "87150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 152.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 152.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, 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[{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC COUNT OF CT IN 12MO", "code_information": [{"code": "G9321", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC DAILY ASPIRIN OR CONTRA", "code_information": [{"code": "G9277", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", 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[{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC NO DAILY ASPIRIN", "code_information": [{"code": "G9278", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC OF DSM-IV INIT EVAL", "code_information": [{"code": "G9212", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": 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"standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO POS AIR PRESS", "code_information": [{"code": "G8849", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO SLEEP APNEA", "code_information": [{"code": "G8840", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO STATIN MED DISCH", "code_information": [{"code": "G8817", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC REAS NO STATIN THERAPY", "code_information": [{"code": "G8815", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC SHARE DEC PRIOR PROC", "code_information": [{"code": "G9296", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC TYPE NSM LUNG CA", "code_information": [{"code": "G9289", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC VIRAL LOAD <200", "code_information": [{"code": "G9243", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOC VIRAL LOAD >=200", "code_information": [{"code": "G9242", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOCETAXEL (INGENUS), 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9172", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.7, "maximum": 50.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOCREV CUR MEDS BY ELIG CLIN", "code_information": [{"code": "G8427", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOFETILDE .125MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304230", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DOFETILDE .125MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304230", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DOFETILDE .25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304231", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DOFETILDE .25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304231", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DOFETILDE .5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304233", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOFETILDE .5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304233", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOLASETRON 50 MG", "code_information": [{"code": "S0174", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.33, "maximum": 33.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOLASETRON MESYLATE ORAL", "code_information": [{"code": "Q0180", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOLUTEGRAVIR 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304257", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 401.0, "discounted_cash": 300.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOLUTEGRAVIR 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304257", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 401.0, "discounted_cash": 300.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME PATELLA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 527.31, "maximum": 527.31, "gross_charge": 2511.0, "discounted_cash": 1883.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 527.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY LAPS LIV", "code_information": [{"code": "666T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN CDVR", "code_information": [{"code": "664T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN LIV", "code_information": [{"code": "665T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY RCP UTER", "code_information": [{"code": "667T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DONEPEZIL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304250", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DONEPEZIL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304250", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DONOR LOBECTOMY (LUNG)", "code_information": [{"code": "S2061", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONOR PANCREATECTOMY", "code_information": [{"code": "48550", "type": "CPT"}], "standard_charges": [{"minimum": 7835.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DONOR PNEUMONECTOMY", "code_information": [{"code": "32850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DONOR SERV IVF CASE RATE", "code_information": [{"code": "S4025", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOPLR VELOC FETL MD CERE", "code_information": [{"code": "76821", "type": "CPT"}, {"code": "5066821", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 218.26, "gross_charge": 938.0, "discounted_cash": 703.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 196.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 218.26, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPLR VELOC FETL UMB ART", "code_information": [{"code": "76820", "type": "CPT"}, {"code": "5017682", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 279.09, "gross_charge": 1329.0, "discounted_cash": 996.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 279.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 75.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 75.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 75.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 75.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 75.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPLR VELOC FETL UMB ART", "code_information": [{"code": "76820", "type": "CPT"}, {"code": "5067682", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 279.09, "gross_charge": 1329.0, "discounted_cash": 996.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 279.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.37, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 75.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 75.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 75.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 75.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 75.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPP FLW/PR MSMNT ADDL", "code_information": [{"code": "93572", "type": "CPT"}, {"code": "4613658", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2129.9, "gross_charge": 2242.0, "discounted_cash": 1681.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 470.82, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 2129.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 2129.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 827.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 1681.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 1681.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPP FLW/PR MSMNT ADDL", "code_information": [{"code": "93572", "type": "CPT"}, {"code": "4613658", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2129.9, "gross_charge": 2242.0, "discounted_cash": 1681.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 470.82, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 2129.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 2129.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 827.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 1681.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 1681.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPP FLW/PR MSMNT INIT", "code_information": [{"code": "93571", "type": "CPT"}, {"code": "4613657", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 12582.75, "gross_charge": 13245.0, "discounted_cash": 9933.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2781.45, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 12582.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 12582.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4887.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 9933.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 9933.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPP FLW/PR MSMNT INIT", "code_information": [{"code": "93571", "type": "CPT"}, {"code": "4613657", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 12582.75, "gross_charge": 13245.0, "discounted_cash": 9933.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2781.45, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 12582.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 12582.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4887.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 9933.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 9933.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO COLOR FLOW", "code_information": [{"code": "93325", "type": "CPT"}, {"code": "4603330", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 91.84, "maximum": 91.84, "gross_charge": 1975.0, "discounted_cash": 1481.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 91.84, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 91.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 91.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 91.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 91.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO PULSE/CONT", "code_information": [{"code": "93320", "type": "CPT"}, {"code": "4603325", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 98.34, "maximum": 98.34, "gross_charge": 2249.0, "discounted_cash": 1686.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 98.34, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 98.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 98.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 98.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 98.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORIPENEM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1267", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.79, "maximum": 0.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORNASE ALFA NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7639", "type": "HCPCS"}], "standard_charges": [{"minimum": 49.64, "maximum": 55.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOSE OPTIMIZATION AUC - 5FU", "code_information": [{"code": "S3722", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOUBLE TRANSFER TOE-HAND", "code_information": [{"code": "26554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3908.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3908.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3908.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3908.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3908.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOXAZOSIN 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304335", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXAZOSIN 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304335", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXAZOSIN 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304336", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXAZOSIN 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304336", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXAZOSIN 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304337", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXAZOSIN 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304337", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXEPIN 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304371", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXEPIN 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304371", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXEPIN 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304342", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXEPIN 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304342", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXEPIN 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304365", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXEPIN 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304365", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXORUBICIN INJ 10MG", "code_information": [{"code": "Q2050", "type": "HCPCS"}], "standard_charges": [{"minimum": 97.62, "maximum": 108.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 97.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 108.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 108.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 108.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 108.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXYCYCLINE 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304392", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXYCYCLINE 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304392", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXYCYCLINE 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304388", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXYCYCLINE 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304388", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXYCYCLINE 5MG/ML 5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315102", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 99.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXYCYCLINE 5MG/ML 5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315102", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 99.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXYCYCLINE HYCLATE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1271", "type": "HCPCS"}, {"code": "5320295", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.1, "maximum": 0.11, "gross_charge": 0.39, "discounted_cash": 0.29, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXYCYCLINE HYCLATE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1271", "type": "HCPCS"}, {"code": "5320295", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.1, "maximum": 0.11, "gross_charge": 0.39, "discounted_cash": 0.29, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DPYD GENE COMMON VARIANT", "code_information": [{"code": "81232", "type": "CPT"}, {"code": "4100281", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 174.81, "maximum": 174.81, "gross_charge": 475.0, "discounted_cash": 356.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN APPENDIX ABSCESS OPEN", "code_information": [{"code": "44900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 688.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 688.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 688.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 688.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 688.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN BL W/CATH INSERTION", "code_information": [{"code": "51102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12877.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 864.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 864.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 864.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 864.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 864.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN BLADDER BY NEEDLE", "code_information": [{"code": "51100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN BLADDER BY TROCAR/CATH", "code_information": [{"code": "51101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN BLD UNDER NAIL", "code_information": [{"code": "6900135", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 811.0, "discounted_cash": 608.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN BLD UNDER NAIL", "code_information": [{"code": "6900135", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 811.0, "discounted_cash": 608.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN BLOOD FROM UNDER NAIL", "code_information": [{"code": "11740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN CHEST LESION", "code_information": [{"code": "21502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN EXTERNAL EAR LESION", "code_information": [{"code": "69000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN EXTERNAL EAR LESION", "code_information": [{"code": "69005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 108.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 108.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 108.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 108.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 108.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN HAND TENDON SHEATH", "code_information": [{"code": "26020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN LOWER LEG BURSA", "code_information": [{"code": "27604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN LOWER LEG LESION", "code_information": [{"code": "27603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN NECK/CHEST LESION", "code_information": [{"code": "21501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN ABDOM ABSCESS", "code_information": [{"code": "49040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 909.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 909.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 909.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 909.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 909.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN LUNG LESION", "code_information": [{"code": "32200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1095.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1095.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1095.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1095.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1095.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN RETROPERI ABSCESS", "code_information": [{"code": "49060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1019.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1019.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1019.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1019.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1019.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OUTER EAR CANAL LESION", "code_information": [{"code": "69020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS OPEN", "code_information": [{"code": "58820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS PERCUT", "code_information": [{"code": "58822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 673.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 673.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 673.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 673.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 673.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN PANCREATIC PSEUDOCYST", "code_information": [{"code": "48510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 983.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 983.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 983.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 983.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 983.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN PENIS LESION", "code_information": [{"code": "54015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BONE LESION", "code_information": [{"code": "23035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BURSA", "code_information": [{"code": "23031", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER LESION", "code_information": [{"code": "23030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN SPINAL CORD CYST", "code_information": [{"code": "62268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN THIGH/KNEE LESION", "code_information": [{"code": "27301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN THYROID/TONGUE CYST", "code_information": [{"code": "60000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN TO PERITONEAL CAVITY", "code_information": [{"code": "49062", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 698.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 698.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 698.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 698.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 698.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/O US", "code_information": [{"code": "20600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6999.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/O US", "code_information": [{"code": "20605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/O US", "code_information": [{"code": "20610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3603.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3178.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE ABDOM ABSCESS OPEN", "code_information": [{"code": "49020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1450.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1450.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1450.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1450.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1450.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE MOUTH ROOF LESION", "code_information": [{"code": "42000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF ABDOMEN", "code_information": [{"code": "48000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1705.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1705.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1705.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1705.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1705.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BLADDER ABSCESS", "code_information": [{"code": "51080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "21510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 472.07, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 472.07, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 472.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 472.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 472.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "26992", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 954.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 954.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 954.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 954.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 954.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "27303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 632.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 632.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 632.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 632.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 632.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BURSA OF FOOT", "code_information": [{"code": "28001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYELID ABSCESS", "code_information": [{"code": "67700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FINGER ABSCESS", "code_information": [{"code": "26010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FINGER ABSCESS", "code_information": [{"code": "26011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FOREARM BURSA", "code_information": [{"code": "25031", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FOREARM LESION", "code_information": [{"code": "25028", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF GLAND ABSCESS", "code_information": [{"code": "56420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF GUM LESION", "code_information": [{"code": "41800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF HIP JOINT", "code_information": [{"code": "27030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 937.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 937.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 937.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 937.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 937.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF HYDROCELE", "code_information": [{"code": "55000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 72.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 72.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 72.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 72.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 72.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF KIDNEY LESION", "code_information": [{"code": "50390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "40800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "40801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41006", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41007", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41008", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41009", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41017", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41018", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [{"code": "58800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [{"code": "58805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PALM BURSA", "code_information": [{"code": "26025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PALM BURSAS", "code_information": [{"code": "26030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC ABSCESS", "code_information": [{"code": "45000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC ABSCESS", "code_information": [{"code": "57010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC FLUID", "code_information": [{"code": "57020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIS BURSA", "code_information": [{"code": "26991", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIS LESION", "code_information": [{"code": "26990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "52700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "55720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "55725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF RECTAL ABSCESS", "code_information": [{"code": "45005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF RECTAL ABSCESS", "code_information": [{"code": "45020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY CYST", "code_information": [{"code": "42409", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SCROTUM", "code_information": [{"code": "54700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SCROTUM ABSCESS", "code_information": [{"code": "55100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63172", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1305.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1305.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1305.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1305.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1305.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63173", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1603.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1603.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1603.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1603.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1603.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF TONSIL ABSCESS", "code_information": [{"code": "42700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 76.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 76.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 76.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 76.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 76.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAW BLOOD OFF VENOUS DEVICE", "code_information": [{"code": "36591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN L", "code_information": [{"code": "16030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN M", "code_information": [{"code": "16025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN S", "code_information": [{"code": "16020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2998.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRESSING CHANGE NOT FOR BURN", "code_information": [{"code": "15852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRGSCRN DIRCT OPT OBS", "code_information": [{"code": "80305", "type": "CPT"}, {"code": "6700305", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.7, "gross_charge": 173.0, "discounted_cash": 129.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 55.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRGSCRN TRIAGE OPT OBS", "code_information": [{"code": "80305", "type": "CPT"}, {"code": "4100402", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.7, "gross_charge": 173.0, "discounted_cash": 129.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 55.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRILL SKULL FOR DRAINAGE", "code_information": [{"code": "61108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 828.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 828.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 828.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 828.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 828.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRILL SKULL FOR IMPLANTATION", "code_information": [{"code": "61107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 309.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 309.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 309.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 309.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 309.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRN OVARY CYST ABDOMINAL", "code_information": [{"code": "5068805", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16811.0, "discounted_cash": 12608.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRONABINOL 2.5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327430", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 30.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRONABINOL 2.5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327430", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 30.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRONABINOL 2.5MG ORAL", "code_information": [{"code": "Q0167", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRONEDARONE 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304405", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRONEDARONE 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304405", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRS INTERCEED", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "8024553", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.71, "maximum": 346.71, "gross_charge": 1651.0, "discounted_cash": 1238.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 346.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRSG/DEBRIDE PT BURN LG", "code_information": [{"code": "6900048", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1728.0, "discounted_cash": 1296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRSG/DEBRIDE PT BURN LG", "code_information": [{"code": "6900048", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1728.0, "discounted_cash": 1296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRSG/DEBRIDE PT BURN MD", "code_information": [{"code": "6900047", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRSG/DEBRIDE PT BURN MD", "code_information": [{"code": "6900047", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRSG/DEBRIDE PT BURN SM", "code_information": [{"code": "6900046", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRSG/DEBRIDE PT BURN SM", "code_information": [{"code": "6900046", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRUG ADMIN & HEMODYNMIC MEAS", "code_information": [{"code": "93463", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY 120+ RX&METABLT", "code_information": [{"code": "328U", "type": "CPT"}], "standard_charges": [{"minimum": 114.43, "maximum": 114.43, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ACETAMINOPHEN", "code_information": [{"code": "80143", "type": "CPT"}], "standard_charges": [{"minimum": 18.64, "maximum": 18.64, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ITRACONAZOLE", "code_information": [{"code": "80189", "type": "CPT"}], "standard_charges": [{"minimum": 27.11, "maximum": 27.11, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY LEFLUNOMIDE", "code_information": [{"code": "80193", "type": "CPT"}], "standard_charges": [{"minimum": 38.57, "maximum": 38.57, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY METHOTREXATE", "code_information": [{"code": "80204", "type": "CPT"}], "standard_charges": [{"minimum": 38.57, "maximum": 38.57, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY POSACONAZOLE", "code_information": [{"code": "80187", "type": "CPT"}], "standard_charges": [{"minimum": 27.11, "maximum": 27.11, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY SALICYLATE", "code_information": [{"code": "80179", "type": "CPT"}], "standard_charges": [{"minimum": 18.64, "maximum": 18.64, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 1-7 CLASSES", "code_information": [{"code": "G0480", "type": "HCPCS"}], "standard_charges": [{"minimum": 114.43, "maximum": 114.43, "estimated_discounted_cash": 887.8, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 15-21 CLASSES", "code_information": [{"code": "G0482", "type": "HCPCS"}], "standard_charges": [{"minimum": 198.74, "maximum": 198.74, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 198.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 198.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 22+ CLASSES", "code_information": [{"code": "G0483", "type": "HCPCS"}], "standard_charges": [{"minimum": 246.92, "maximum": 246.92, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 246.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 246.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 8-14 CLASSES", "code_information": [{"code": "G0481", "type": "HCPCS"}], "standard_charges": [{"minimum": 156.59, "maximum": 156.59, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 156.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 156.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF SIMPLE ALL CL", "code_information": [{"code": "G0659", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.14, "maximum": 62.14, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", 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{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - 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and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 0.6-1", "code_information": [{"code": "17271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 1.1-2", "code_information": [{"code": "17272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 2.1-3", "code_information": [{"code": "17273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 99.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 99.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 99.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 99.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 99.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 3.1-4", "code_information": [{"code": "17274", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 113.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 113.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 113.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 113.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 113.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G >4.0", "code_information": [{"code": "17276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M .5/<", "code_information": [{"code": "17280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M .6-1", "code_information": [{"code": "17281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M1.1-2", "code_information": [{"code": "17282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 97.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 97.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 97.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 97.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 97.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M2.1-3", "code_information": [{"code": "17283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 112.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 112.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 112.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 112.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 112.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M3.1-4", "code_information": [{"code": "17284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M>4.0", "code_information": [{"code": "17286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ EXTENSIVE RETINOPATHY", "code_information": [{"code": "67227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ LESION LID MARGIN <1CM", "code_information": [{"code": "67850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L .6-1.0CM", "code_information": [{"code": "17261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 0.5 CM/<", "code_information": [{"code": "17260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 49.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 1.1-2.0", "code_information": [{"code": "17262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 2.1-3.0", "code_information": [{"code": "17263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 3.1-4.0", "code_information": [{"code": "17264", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L >4.0 CM", "code_information": [{"code": "17266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 110.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 110.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 110.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 110.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 110.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ NEUROFIBROMA XTNSV", "code_information": [{"code": "419T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ NEUROFIBROMA XTNSV", "code_information": [{"code": "420T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ NULYT AGT GNCLR NRV", "code_information": [{"code": "64624", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRY EYE LESN,FDR VSSL TECH", "code_information": [{"code": "G0186", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DTAP-HEP B-IPV VACCINE IM", "code_information": [{"code": "90723", "type": "CPT"}], "standard_charges": [{"minimum": 111.23, "maximum": 123.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 111.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 123.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 123.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 123.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 123.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV-HIB-HEPB VACCINE IM", "code_information": [{"code": "90697", "type": "CPT"}], "standard_charges": [{"minimum": 168.34, "maximum": 187.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 168.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 187.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 187.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 187.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 187.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DULOXETINE 20MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304410", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DULOXETINE 20MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304410", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DULOXETINE 30MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304411", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DULOXETINE 30MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304411", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DUODENAL EXCLUSION", "code_information": [{"code": "48547", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1613.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1613.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1613.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1613.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1613.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DUODENAL MOTILITY STUDY", "code_information": [{"code": "91022", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 226.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 226.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 226.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 226.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 226.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DUPLEX CAROTID BI/COMP", "code_information": [{"code": "93880", "type": "CPT"}, {"code": "4636015", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 301.44, "maximum": 359.1, "gross_charge": 2838.0, "discounted_cash": 2128.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 301.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 323.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 314.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 301.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 301.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 301.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 301.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUPLEX CAROTID UNI/LTD", "code_information": [{"code": "93882", "type": "CPT"}, {"code": "4636026", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 153.23, "maximum": 197.28, "gross_charge": 1676.0, "discounted_cash": 1257.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 157.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 153.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC BILIARY DILATN BLLN", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "8182298", "type": "CDM"}], "standard_charges": [{"minimum": 1279.74, "maximum": 1279.74, "gross_charge": 6094.0, "discounted_cash": 4570.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC EMBOLIC PROTECTION", "code_information": [{"code": "C1884", "type": "HCPCS"}, {"code": "8174014", "type": "CDM"}], "standard_charges": [{"minimum": 1139.04, "maximum": 1139.04, "gross_charge": 5424.0, "discounted_cash": 4068.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1139.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC ENDOLUMINL FRED 21 FLW DIR", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8060304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3012.45, "maximum": 3012.45, "gross_charge": 14345.0, "discounted_cash": 10758.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3012.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC FIXATION ADJUSTABLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2441.04, "maximum": 2441.04, "gross_charge": 11624.0, "discounted_cash": 8718.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2441.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC FX SYNDESMOSIS SYNCH GRVTY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1104.18, "maximum": 1104.18, "gross_charge": 5258.0, "discounted_cash": 3943.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1104.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC LORDOTC INTG INTRBDY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2395.26, "maximum": 2395.26, "gross_charge": 11406.0, "discounted_cash": 8554.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2395.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC REP URIN TVT OBTUR", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "4021029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1976.31, "maximum": 1976.31, "gross_charge": 9411.0, "discounted_cash": 7058.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1976.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC REP URN SLING REMEEX", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "4021028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.31, "maximum": 1724.31, "gross_charge": 8211.0, "discounted_cash": 6158.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1724.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC SUT CAPTR CAPIO SLIM", "code_information": [{"code": "C2631", "type": "HCPCS"}, {"code": "8195406", "type": "CDM"}], "standard_charges": [{"minimum": 647.01, "maximum": 647.01, "gross_charge": 3081.0, "discounted_cash": 2310.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 647.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC TISS LOCALZTN/EXCSN", "code_information": [{"code": "C1819", "type": "HCPCS"}, {"code": "8241819", "type": "CDM"}], "standard_charges": [{"minimum": 605.64, "maximum": 605.64, "gross_charge": 2884.0, "discounted_cash": 2163.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 605.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC TROCHANTER FIX W CBL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2372.37, "maximum": 2372.37, "gross_charge": 11297.0, "discounted_cash": 8472.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2372.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC TROCHANTER FX W CBL2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131573", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2075.85, "maximum": 2075.85, "gross_charge": 9885.0, "discounted_cash": 7413.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2075.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX ALY AUD OI SND PRCSR 1ST", "code_information": [{"code": "92622", "type": "CPT"}], "standard_charges": [{"minimum": 191.17, "maximum": 218.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 196.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 191.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 218.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 218.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 218.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW ASP/BX MULTI", "code_information": [{"code": "4910364", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8598.0, "discounted_cash": 6448.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DX BONE MARROW ASP/BX MULTI", "code_information": [{"code": "5050364", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6020.0, "discounted_cash": 4515.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DX BONE MARROW ASPIRATION(S)", "code_information": [{"code": "4911990", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7288.0, "discounted_cash": 5466.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DX BONE MARROW ASPIRATIONS", "code_information": [{"code": "38220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 117.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 117.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 117.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 117.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 117.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW BIOPSIES", "code_information": [{"code": "4918221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1828.0, "discounted_cash": 1371.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DX BONE MARROW BIOPSIES", "code_information": [{"code": "5058221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3696.0, "discounted_cash": 2772.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DX BONE MARROW BIOPSIES", "code_information": [{"code": "38221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW BX & ASPIR", "code_information": [{"code": "38222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BRONCH W/ NAVIGATION", "code_information": [{"code": "C7509", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/BRUSH", "code_information": [{"code": "31623", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8688.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/LAVAGE", "code_information": [{"code": "31624", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8934.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/WASH", "code_information": [{"code": "31622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9870.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX DARK ADAPTATION EXAM I&R", "code_information": [{"code": "92284", "type": "CPT"}], "standard_charges": [{"minimum": 77.84, "maximum": 542.27, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 77.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 488.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 474.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 542.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 542.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 542.27, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 77.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 77.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 77.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 77.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPEC", "code_information": [{"code": "43756", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPECS", "code_information": [{"code": "43757", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX GASTR INTUB W/ASP SPEC", "code_information": [{"code": "43754", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX GASTR INTUB W/ASP SPECS", "code_information": [{"code": "43755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP EPCAR US CHD I&R", "code_information": [{"code": "76989", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP EPICAR CAR US CHD", "code_information": [{"code": "76987", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP THORACIC AORTA US", "code_information": [{"code": "76984", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY EXCL NB", "code_information": [{"code": "31525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY NEWBORN", "code_information": [{"code": "31520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY W/OPER SCOPE", "code_information": [{"code": "31526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX LMBR SPI PNXR", "code_information": [{"code": "62270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6440.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX LMBR SPI PNXR W/FLUOR/CT", "code_information": [{"code": "62328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX MAMMO+CAD BILAT", "code_information": [{"code": "77066", "type": "CPT"}, {"code": "3070204", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 334.94, "gross_charge": 1637.0, "discounted_cash": 1227.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 334.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX MAMMO+CAD BILAT", "code_information": [{"code": "77066", "type": "CPT"}, {"code": "5010212", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 334.94, "gross_charge": 1637.0, "discounted_cash": 1227.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 334.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX MAMMO+CAD UNILAT", "code_information": [{"code": "77065", "type": "CPT"}, {"code": "3070206", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 269.7, "gross_charge": 1074.0, "discounted_cash": 805.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 269.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 91.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 91.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX MAMMO+CAD UNILAT", "code_information": [{"code": "77065", "type": "CPT"}, {"code": "5010206", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 269.7, "gross_charge": 1074.0, "discounted_cash": 805.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 269.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 91.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 91.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX NTROP EPCR US CHD IMG ACQ", "code_information": [{"code": "76988", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNAMIC CAVERNOSOMETRY", "code_information": [{"code": "54231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"billing_class": "facility"}]}, {"description": "DYNAMIC STANDING FRAME", "code_information": [{"code": "E0642", "type": "HCPCS"}], "standard_charges": [{"minimum": 3831.51, "maximum": 4381.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3944.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3831.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4381.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4381.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4381.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNAMIC SURFACE EMG", "code_information": [{"code": "96002", "type": "CPT"}], "standard_charges": [{"minimum": 20.58, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYPHYLLINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1180", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.25, "maximum": 8.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYSEQUILIBRIUM", "code_information": [{"code": "149", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24954.62, "maximum": 31446.19, "estimated_discounted_cash": 58983.59, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24954.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31446.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dementia measures group", "code_information": [{"code": "G8902", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dementia mg qual act perform", "code_information": [{"code": "G8761", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dermal filler inj px/suppl", "code_information": [{"code": "C9800", "type": "HCPCS"}], "standard_charges": [{"minimum": 12252.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Diabetes screen", "code_information": [{"code": "G8777", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dicom format doc on rpt", "code_information": [{"code": "G9340", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dil macular/fundus not perfo", "code_information": [{"code": "G8398", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Dm meas qual act perform", "code_information": [{"code": "G8494", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc antibio given b/4 surg", "code_information": [{"code": "G8630", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc antibio order b/4 surg", "code_information": [{"code": "G8629", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc cath >90d for maint dia", "code_information": [{"code": "G9265", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc comp or mort w in 30d", "code_information": [{"code": "G9267", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc comp or mort w in 90d", "code_information": [{"code": "G9268", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc compl inf antibio", "code_information": [{"code": "G9301", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc dx ckd", "code_information": [{"code": "G8771", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc med reas bp not control", "code_information": [{"code": "G8887", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc med reas no antihtrom", "code_information": [{"code": "G8896", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc med reas no counsel diet", "code_information": [{"code": "G8781", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc med reas no diabete scrn", "code_information": [{"code": "G8778", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc med reas no ldl-c contrl", "code_information": [{"code": "G8891", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc med reas no ldl-c test", "code_information": [{"code": "G8892", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc med reas no lipid profle", "code_information": [{"code": "G8768", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc med reas no serum crtn", "code_information": [{"code": "G8775", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc med reas no urine protn", "code_information": [{"code": "G8772", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc medrsn no compl antibio", "code_information": [{"code": "G9300", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc no antibi order b/4 surg", "code_information": [{"code": "G8632", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc no comp or mort w in 30d", "code_information": [{"code": "G9269", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc no comp or mort w in 90d", "code_information": [{"code": "G9270", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc no pain comfort 48hr", "code_information": [{"code": "G9251", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc not eligible for dep med", "code_information": [{"code": "G9193", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc of death post-aaa repair", "code_information": [{"code": "G9262", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc of disch post-aaa repair", "code_information": [{"code": "G9263", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc of pain comfort 48hr", "code_information": [{"code": "G9250", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc of pat death after cas", "code_information": [{"code": "G9256", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc of pat death after cea", "code_information": [{"code": "G9260", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc of pat stroke after cas", "code_information": [{"code": "G9257", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc of pat stroke after cea", "code_information": [{"code": "G9258", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc pain as nt perf, not elg", "code_information": [{"code": "G8442", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc pt reas no assess", "code_information": [{"code": "G0921", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc pt reas on counsel diet", "code_information": [{"code": "G8949", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc pt w cath maint dia", "code_information": [{"code": "G9240", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc pt w out cath maint dia", "code_information": [{"code": "G9241", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc reas biopsy not review", "code_information": [{"code": "G8884", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc reas no lipid profile", "code_information": [{"code": "G8726", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc reas no rh-immuno", "code_information": [{"code": "G8810", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc reason for no vte", "code_information": [{"code": "G9199", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc rsn for ord ct scan", "code_information": [{"code": "G9348", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc rsn hemod & cath acc", "code_information": [{"code": "G9239", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Doc rsn hemod w/cath >=90d", "code_information": [{"code": "G9264", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Drug metabolism (adverse drug reactions and drug response), genotyping of 16 genes (ie, ABCG2, CYP2B6, CYP2C9, CYP2C19, CYP2C, CYP2D6, CYP3A5, CYP4F2, DPYD, G6PD, GGCX, NUDT15, SLCO1B1, TPMT, UGT1A1, VKORC1), reported as metabolizer status and transporter", "code_information": [{"code": "533U", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Drug metabolism, psychiatry (eg, major depressive disorder, general anxiety disorder, attention deficit hyperactivity disorder [ADHD], schizophrenia), whole blood, buccal swab, and pharmacogenomic genotyping of 14 genes and CYP2D6 copy number variant anal", "code_information": [{"code": "476U", "type": "CPT"}], "standard_charges": [{"minimum": 416.78, "maximum": 416.78, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Drug metabolism, psychiatry (eg, major depressive disorder, general anxiety disorder, attention deficit hyperactivity disorder [ADHD], schizophrenia), whole blood, buccal swab, and pharmacogenomic genotyping of 14 genes and CYP2D6 copy number variant anal", "code_information": [{"code": "477U", "type": "CPT"}], "standard_charges": [{"minimum": 416.78, "maximum": 416.78, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL IV", "code_information": [{"code": "99204", "type": "CPT"}, {"code": "4549204", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 150.71, "maximum": 150.71, "gross_charge": 880.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL IV", "code_information": [{"code": "99204", "type": "CPT"}, {"code": "6290236", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 150.71, "maximum": 150.71, "gross_charge": 880.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL IV", "code_information": [{"code": "99204", "type": "CPT"}, {"code": "6901004", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 150.71, "maximum": 150.71, "gross_charge": 880.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL IV", "code_information": [{"code": "99204", "type": "CPT"}, {"code": "6901004", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 150.71, "maximum": 150.71, "gross_charge": 880.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL IV", "code_information": [{"code": "99204", "type": "CPT"}, {"code": "6920014", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 150.71, "maximum": 150.71, "gross_charge": 646.0, "discounted_cash": 484.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL IV", "code_information": [{"code": "99204", "type": "CPT"}, {"code": "6920014", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 150.71, "maximum": 150.71, "gross_charge": 646.0, "discounted_cash": 484.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 150.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL V", "code_information": [{"code": "99205", "type": "CPT"}, {"code": "4549205", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 188.86, "maximum": 188.86, "gross_charge": 1196.0, "discounted_cash": 897.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL V", "code_information": [{"code": "99205", "type": "CPT"}, {"code": "4549205", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 188.86, "maximum": 188.86, "gross_charge": 1196.0, "discounted_cash": 897.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL V", "code_information": [{"code": "99205", "type": "CPT"}, {"code": "6290238", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 188.86, "maximum": 188.86, "gross_charge": 1196.0, "discounted_cash": 897.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL V", "code_information": [{"code": "99205", "type": "CPT"}, {"code": "6901005", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 188.86, "maximum": 188.86, "gross_charge": 1196.0, "discounted_cash": 897.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL V", "code_information": [{"code": "99205", "type": "CPT"}, {"code": "6901005", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 188.86, "maximum": 188.86, "gross_charge": 1196.0, "discounted_cash": 897.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL V", "code_information": [{"code": "99205", "type": "CPT"}, {"code": "6920016", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 188.86, "maximum": 188.86, "gross_charge": 908.0, "discounted_cash": 681.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "E&M-NEW PATIENT-LVL V", "code_information": [{"code": "99205", "type": "CPT"}, {"code": "6920016", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 188.86, "maximum": 188.86, "gross_charge": 908.0, "discounted_cash": 681.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EA MLTPLX STAIN MANUAL", "code_information": [{"code": "88377", "type": "CPT"}, {"code": "7270098", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1576.76, "gross_charge": 1014.0, "discounted_cash": 760.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1576.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR AND THROAT EXAMINATION", "code_information": [{"code": "92502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 99.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 682.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 663.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 758.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 758.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 758.72, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 99.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 99.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 99.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 99.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR CARTILAGE GRAFT", "code_information": [{"code": "21235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR MICROSCOPY EXAMINATION", "code_information": [{"code": "92504", "type": "CPT"}], "standard_charges": [{"minimum": 31.76, "maximum": 31.76, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.76, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR PROTECTOR EVALUATION", "code_information": [{"code": "92596", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [{"code": "147", "type": "MS-DRG"}], "standard_charges": [{"minimum": 42216.34, "maximum": 53198.29, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42216.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 53198.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [{"code": "146", "type": "MS-DRG"}], "standard_charges": [{"minimum": 70301.91, "maximum": 88589.9, "estimated_discounted_cash": 127991.65, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 70301.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 88589.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "148", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26465.31, "maximum": 33349.87, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26465.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33349.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EARDRUM REVISION", "code_information": [{"code": "69450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EARLY IND/DELIVERY", "code_information": [{"code": "G9356", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECALLANTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1290", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.97, "maximum": 579.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 521.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 579.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 579.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 579.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 579.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93224", "type": "CPT"}], "standard_charges": [{"minimum": 161.65, "maximum": 213.49, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 161.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 192.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 186.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 213.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 213.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 213.49, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 161.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 161.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 161.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 161.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93227", "type": "CPT"}], "standard_charges": [{"minimum": 28.94, "maximum": 59.78, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 52.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG RECORD/REVIEW", "code_information": [{"code": "93268", "type": "CPT"}], "standard_charges": [{"minimum": 330.39, "maximum": 492.43, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 330.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 443.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 430.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 492.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 492.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 492.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 330.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 330.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 330.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 330.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/MONITORING AND ANALYSIS", "code_information": [{"code": "93271", "type": "CPT"}], "standard_charges": [{"minimum": 160.08, "maximum": 265.45, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 265.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 164.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 160.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 265.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 265.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 265.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 265.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/REVIEW INTERPRET ONLY", "code_information": [{"code": "93272", "type": "CPT"}], "standard_charges": [{"minimum": 27.56, "maximum": 57.15, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 51.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 49.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.15, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/SIGNAL-AVERAGED", "code_information": [{"code": "93278", "type": "CPT"}], "standard_charges": [{"minimum": 54.94, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 54.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 54.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 54.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 54.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 54.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO 2D LIMITED W/CONTR", "code_information": [{"code": "C8924", "type": "HCPCS"}, {"code": "4608924", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 368.13, "maximum": 601.02, "gross_charge": 1753.0, "discounted_cash": 1314.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 368.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 541.01, "methodology": "fee 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"standard_charge_dollar": 774.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHOCARDIOGRAM EX STRESS", "code_information": [{"code": "93350", "type": "CPT"}, {"code": "4603350", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 226.69, "maximum": 774.86, "gross_charge": 3407.0, "discounted_cash": 2555.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 226.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 697.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 677.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 226.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 226.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 226.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 226.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHOCARDIOGRAM EX STRESS", "code_information": [{"code": "93350", "type": "CPT"}, {"code": "4633350", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 226.69, "maximum": 774.86, "gross_charge": 4266.0, "discounted_cash": 3199.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 226.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 697.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 677.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 226.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 226.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 226.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 226.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHOSCLEROTHERAPY", "code_information": [{"code": "S2202", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [{"code": "3", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13705.0, "maximum": 888041.14, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13705.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 704719.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 888041.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT ARTERY", "code_information": [{"code": "33949", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT-VENOUS", "code_information": [{"code": "33948", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION ARTERY", "code_information": [{"code": "33947", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION VENOUS", "code_information": [{"code": "33946", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33956", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33952", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33953", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33954", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33957", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33958", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33959", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33962", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33963", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33964", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL CTR CANNULA", "code_information": [{"code": "33985", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL CTR CANNULA", "code_information": [{"code": "33986", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33965", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33969", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PRPH CANNULA", "code_information": [{"code": "33966", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PRPH CANNULA", "code_information": [{"code": "33984", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECOG IMPLTD BRN NPGT <30 D", "code_information": [{"code": "95836", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECP CILIARY BODY DESTRUCTION", "code_information": [{"code": "66711", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECT SNGL SEIZURE", "code_information": [{"code": "90870", "type": "CPT"}, {"code": "3220870", "type": "CDM"}, {"code": "901", "type": "RC"}], "standard_charges": [{"minimum": 120.96, "maximum": 709.1, "gross_charge": 2239.0, "discounted_cash": 1679.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 120.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 120.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 120.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 120.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 120.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECT SNGL SEIZURE", "code_information": [{"code": "90870", "type": "CPT"}, {"code": "6402020", "type": "CDM"}, {"code": "901", "type": "RC"}], "standard_charges": [{"minimum": 120.96, "maximum": 709.1, "gross_charge": 5337.0, "discounted_cash": 4002.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 120.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 120.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 120.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 120.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 120.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED SVC CKD GRP PER SESSION", "code_information": [{"code": "G0421", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ED SVC CKD IND PER SESSION", "code_information": [{"code": "G0420", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EDETATE CALCIUM DISODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0600", "type": "HCPCS"}], "standard_charges": [{"minimum": 5767.54, "maximum": 6408.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5767.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6408.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6408.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6408.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6408.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EDETATE DISODIUM PER 150 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3520", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.47, "maximum": 0.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EDUC/TRN 45 MIN", "code_information": [{"code": "G0177", "type": "HCPCS"}, {"code": "6422042", "type": "CDM"}, {"code": "913", "type": "RC"}], "standard_charges": [{"minimum": 150.15, "maximum": 150.15, "gross_charge": 715.0, "discounted_cash": 536.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 150.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EE&MJ BSC PRTN ELISA EST DEV", "code_information": [{"code": "95U", "type": "CPT"}], "standard_charges": [{"minimum": 771.98, "maximum": 771.98, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 771.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 771.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG AWAKE/DROWSY", "code_information": [{"code": "95816", "type": "CPT"}, {"code": "4805817", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 248.34, "maximum": 392.98, "gross_charge": 2228.0, "discounted_cash": 1671.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 248.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE 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SLEEP ONLY", "code_information": [{"code": "95822", "type": "CPT"}], "standard_charges": [{"minimum": 275.47, "maximum": 392.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 275.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED 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[{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 267.82, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 267.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 267.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 267.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 267.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG MONITORING 61-119 MINS", "code_information": [{"code": "95813", "type": "CPT"}, {"code": "4805834", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 330.64, "maximum": 392.98, "gross_charge": 3156.0, "discounted_cash": 2367.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 330.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", 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"standard_charges": [{"minimum": 4.19, "maximum": 4.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EFAVIRENZ 200MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304431", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "billing_class": "facility"}]}, {"description": "EFAVIRENZ 200MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304431", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "billing_class": "facility"}]}, {"description": "EGD BALLOON DIL ESOPH30 MM/>", "code_information": [{"code": "43233", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 8487.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD BIOPSY SINGLE/MULTIPLE", "code_information": [{"code": "43239", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8487.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD CAUTERY TUMOR POLYP", "code_information": [{"code": "43250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4625.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD CONTROL BLEEDING ANY", "code_information": [{"code": "43255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7871.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD DIAGNOSTIC BRUSH WASH", "code_information": [{"code": "43235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5141.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD DILATE STRICTURE", "code_information": [{"code": "43245", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD ENDO MUCOSAL RESECTION", "code_information": [{"code": "43254", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6162.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD ENDOSCOPIC STENT PLACE", "code_information": [{"code": "43266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD ESOPHAGOGASTRC FNDOPLSTY", "code_information": [{"code": "43210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 12079.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL BX 1/MLT", "code_information": [{"code": "653T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL DX BR/WA", "code_information": [{"code": "652T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL TUBE/CATH", "code_information": [{"code": "654T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL DPLMNT BALO", "code_information": [{"code": "43290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL RMVL BALO", "code_information": [{"code": "43291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD GUIDE WIRE INSERTION", "code_information": [{"code": "43248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5834.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD INJECTION VARICES", "code_information": [{"code": "43243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD LESION ABLATION", "code_information": [{"code": "43270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 8632.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 4625.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10307.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD REMOVE FOREIGN BODY", "code_information": [{"code": "43247", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9806.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD REMOVE LESION SNARE", "code_information": [{"code": "43251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5959.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD TUBE/CATH INSERTION", "code_information": [{"code": "43241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD US EXAM DUODENUM/JEJUNUM", "code_information": [{"code": "43259", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7745.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9669.65, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43242", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8803.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD US TRANSMURAL INJXN/MARK", "code_information": [{"code": "43253", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD VARICES LIGATION", "code_information": [{"code": "43244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9031.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD VOL ADJMT BARIATRIC BALO", "code_information": [{"code": "813T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W/THRML TXMNT GERD", "code_information": [{"code": "43257", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1131.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1131.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1131.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1131.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1131.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W/TRANSMURAL DRAIN CYST", "code_information": [{"code": "43240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGFR COMMON VARIANTS", "code_information": [{"code": "81235", "type": "CPT"}, {"code": "7270017", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1235.38, "gross_charge": 3055.0, "discounted_cash": 2291.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1235.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 324.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 324.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EHRLICHA CHAFFEENSIS AMP PRB", "code_information": [{"code": "87484", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 35.09, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EHRLICHIA AB/2", "code_information": [{"code": "86666", "type": "CPT"}, {"code": "7256643", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.9, "gross_charge": 233.0, "discounted_cash": 174.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EHRLICHIA AB/4", "code_information": [{"code": "86666", "type": "CPT"}, {"code": "7256649", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.9, "gross_charge": 233.0, "discounted_cash": 174.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EIA HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0432", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.57, "maximum": 19.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG 12 LEAD TRACING", "code_information": [{"code": "93005", "type": "CPT"}, {"code": "6103005", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 17.17, "maximum": 87.06, "gross_charge": 762.0, "discounted_cash": 571.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE 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"plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG FOR INITIAL PREVENT EXAM", "code_information": [{"code": "G0403", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.94, "maximum": 39.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 35.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG INTERPRET & REPORT PREVE", "code_information": [{"code": "G0405", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.66, "maximum": 19.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG MNTR SCN W/RPT 48 HR", "code_information": [{"code": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 117.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 117.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 117.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 117.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY", "code_information": [{"code": "29830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29834", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29837", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29838", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELD MAL SCRN POS NO PLAN", "code_information": [{"code": "G8735", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELD MALTREATMENT NOT DOC", "code_information": [{"code": "G8535", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC ALY CPX IINS SP/SAC NRV", "code_information": [{"code": "789T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC ALY SMP IINS SP/SAC NRV", "code_information": [{"code": "788T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC ALYS CPLX PRGRMG IINS", "code_information": [{"code": "590T", "type": "CPT"}], "standard_charges": [{"minimum": 148.04, "maximum": 169.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 152.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 148.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 169.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 169.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 169.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC ALYS SMPL PRGRMG IINS", "code_information": [{"code": "589T", "type": "CPT"}], "standard_charges": [{"minimum": 148.04, "maximum": 169.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 152.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 148.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 169.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 169.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 169.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC IMPD SPECTRSC 1+SKN LES", "code_information": [{"code": "658T", "type": "CPT"}], "standard_charges": [{"minimum": 55.66, "maximum": 55.66, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC STIM OTHER THAN WOUND", "code_information": [{"code": "G0283", "type": "HCPCS"}], "standard_charges": [{"estimated_discounted_cash": 291.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC STIM UNATTEND FOR PRESS", "code_information": [{"code": "G0281", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECT STIM WOUND CARE NOT PD", "code_information": [{"code": "G0282", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRIC STIMULATION THERAPY", "code_information": [{"code": "97014", "type": "CPT"}], "standard_charges": [{"minimum": 11.61, "maximum": 34.69, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 31.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20974", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20975", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 176.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 176.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 176.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 176.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 176.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TEST ONE", "code_information": [{"code": "92594", "type": "CPT"}], "standard_charges": [{"minimum": 38.51, "maximum": 44.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 39.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 38.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 44.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 44.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 44.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TST BOTH", "code_information": [{"code": "92595", "type": "CPT"}], "standard_charges": [{"minimum": 82.93, "maximum": 94.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 85.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 82.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 94.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 94.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 94.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO-OCULOGRAPHY W/I&R", "code_information": [{"code": "92270", "type": "CPT"}], "standard_charges": [{"minimum": 94.51, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO-UROFLOWMETRY FIRST", "code_information": [{"code": "51741", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM COMPLETE", "code_information": [{"code": "93000", "type": "CPT"}], "standard_charges": [{"minimum": 26.04, "maximum": 39.96, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 35.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM REPORT", "code_information": [{"code": "93010", "type": "CPT"}], "standard_charges": [{"minimum": 8.87, "maximum": 19.05, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCOCHLEOGRAPHY", "code_information": [{"code": "92584", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRODE STIM BRAIN ADD-ON", "code_information": [{"code": "95962", "type": "CPT"}], "standard_charges": [{"minimum": 234.06, "maximum": 234.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 234.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 234.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 234.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 234.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 234.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRODE STIMULATION BRAIN", "code_information": [{"code": "95961", "type": "CPT"}], "standard_charges": [{"minimum": 248.61, "maximum": 1421.7, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 248.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1243.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 248.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 248.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 248.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 248.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROEJACULATION", "code_information": [{"code": "55870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROGASTROGRAPHY", "code_information": [{"code": "91132", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROGASTROGRAPHY W/TEST", "code_information": [{"code": "91133", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROLYTE PANEL", "code_information": [{"code": "80051", "type": "CPT"}, {"code": "4100004", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.77, "gross_charge": 347.0, "discounted_cash": 260.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 35.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.8, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROMAGNETIC THERAPY ONC", "code_information": [{"code": "G0295", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTROMAGNTIC TX FOR ULCERS", "code_information": [{"code": "G0329", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELECTRON BEAM COMPUTED TOMOG", "code_information": [{"code": "S8092", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRON MICROSCOPY DIAG", "code_information": [{"code": "88348", "type": "CPT"}, {"code": "4308348", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1517.45, "gross_charge": 2651.0, "discounted_cash": 1988.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1517.45, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 691.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 691.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 691.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 691.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 691.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHORETIC TECHNIQ", "code_information": [{"code": "82664", "type": "CPT"}, {"code": "7252656", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 175.2, "gross_charge": 231.0, "discounted_cash": 173.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 175.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGIC STUDY", "code_information": [{"code": "93624", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10612.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7146.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6942.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10612.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93644", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED 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18.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELOSULFASE ALFA, INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1322", "type": "HCPCS"}], "standard_charges": [{"minimum": 277.81, "maximum": 308.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 277.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 308.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 308.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 308.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 308.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EMBEDDED IP CATH EXIT-SITE", "code_information": [{"code": "49436", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 176.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 176.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 176.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 176.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 176.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EMBRYO HATCHING", "code_information": [{"code": "89253", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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billed charges"}], "billing_class": "facility"}]}, {"description": "EMER RSPNS SYSTEM PURCHASE", "code_information": [{"code": "S5162", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMERGENCY TRACHEOTOMY", "code_information": [{"code": "D7990", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EMG ONE EXTREMITY", "code_information": [{"code": "95860", "type": "CPT"}, {"code": "4705860", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 94.25, "maximum": 165.85, "gross_charge": 839.0, "discounted_cash": 629.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS 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[{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EMG TWO EXTREMITIES", "code_information": [{"code": "95861", "type": "CPT"}, {"code": "4705861", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 126.9, "maximum": 165.85, "gross_charge": 1539.0, "discounted_cash": 1154.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 126.9, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"description": "EMPAGLIFLOZIN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304472", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EMPAGLIFLOZIN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304472", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EMTRICITABINE 200MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304456", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 62.25, "setting": "both", "billing_class": 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"billing_class": "facility"}]}, {"description": "ENALAPRIL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304439", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENALAPRIL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304439", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENALAPRIL 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304434", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENALAPRIL 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304434", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENALAPRIL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304437", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENALAPRIL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304437", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENCEPHALITIS CA LCROS AB", "code_information": [{"code": "86651", "type": "CPT"}, {"code": "7256205", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENCEPHALITIS EAST EQ AB", "code_information": [{"code": "86652", "type": "CPT"}, {"code": "7030019", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENCEPHALITIS ST LOUIS AB", "code_information": [{"code": "86653", "type": "CPT"}, {"code": "7030022", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENCEPHALITIS WEST EQ AB", "code_information": [{"code": "86654", "type": "CPT"}, {"code": "7056656", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "END OF LIFE COUNSELING", "code_information": [{"code": "S0257", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDO ASSAY SEVEN ANAL", "code_information": [{"code": "81506", "type": "CPT"}], "standard_charges": [{"minimum": 68.92, "maximum": 68.92, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 68.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 68.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO CATH BILIARY SYSTEM", "code_information": [{"code": "74328", "type": "CPT"}, {"code": "4904328", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 493.5, "gross_charge": 2350.0, "discounted_cash": 1762.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 493.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO CHEM/ABLAT PERC INIT VN", "code_information": [{"code": "4916482", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 22723.0, "discounted_cash": 17042.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO CHEM/ABLAT PERC SUBQ VN", "code_information": [{"code": "4916483", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11481.0, "discounted_cash": 8610.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO CHOLANGIOPANCREATOGRAPH", "code_information": [{"code": "43261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5573.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDO CHOLANGIOPANCREATOGRAPH", "code_information": [{"code": "43262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5210.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDO LASER/ABLAT EXT INIT VN", "code_information": [{"code": "4916478", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10321.0, "discounted_cash": 7740.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO LASER/ABLAT EXT SUBS VN", "code_information": [{"code": "4916479", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10321.0, "discounted_cash": 7740.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO OUTLET RESTRICT W/TUBE", "code_information": [{"code": "C9785", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 26018.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDO RF/ABLAT EXT SUBS VN", "code_information": [{"code": "4916476", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10321.0, "discounted_cash": 7740.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO RF/ABLAT PERC INIT VN", "code_information": [{"code": "4916475", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10321.0, "discounted_cash": 7740.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO SLEEVE GASTRO W/TUBE", "code_information": [{"code": "C9784", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6694.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDO US-GUIDE HEP PORTO GRAD", "code_information": [{"code": "C9768", "type": "HCPCS"}], "standard_charges": [{"minimum": 4200.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO, COLON, RETRO IMAGING", "code_information": [{"code": "C1749", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOCERV CURETTAGE W/SCOPE", "code_information": [{"code": "57456", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCERVICAL CURETTAGE", "code_information": [{"code": "57505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 51.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 51.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 51.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 51.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 51.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH CC", "code_information": [{"code": "644", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34032.05, "maximum": 42884.97, "estimated_discounted_cash": 58509.22, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 34032.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42884.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [{"code": "643", "type": "MS-DRG"}], "standard_charges": [{"minimum": 54653.81, "maximum": 68871.18, "estimated_discounted_cash": 82105.94, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 54653.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 68871.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "645", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25509.1, "maximum": 32144.9, "estimated_discounted_cash": 36314.5, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25509.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32144.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOLUM BX URTR RNL PLVS", "code_information": [{"code": "4910606", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7433.0, "discounted_cash": 5574.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX BILIARY TREE", "code_information": [{"code": "47543", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX URTR RNL PLVS", "code_information": [{"code": "50606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOMETR ABLATE THERMAL", "code_information": [{"code": "58353", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6586.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOMETRIAL CRYOABLATION", "code_information": [{"code": "58356", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6586.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1925.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1925.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1925.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1925.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1925.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOMYSIAL AB", "code_information": [{"code": "86231", "type": "CPT"}, {"code": "7258676", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.09, "maximum": 12.09, "gross_charge": 75.0, "discounted_cash": 56.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOPROSTH BLN VIABAHN V", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028387", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOPROSTH PERIPH VIABAH", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4021031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC INJECTION/IMPLANT", "code_information": [{"code": "51715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14294.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC PANCREATOSCOPY", "code_information": [{"code": "43273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 5056.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC US EXAM ESOPH", "code_information": [{"code": "43237", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8091.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC VEIN HARVEST", "code_information": [{"code": "33508", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY BOWEL POUCH/BIOP", "code_information": [{"code": "44386", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY LIGATE PERF VEINS", "code_information": [{"code": "37500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY MAXILLARY SINUS", "code_information": [{"code": "31267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5974.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF BOWEL POUCH", "code_information": [{"code": "44385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 395.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF URETER", "code_information": [{"code": "50951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF URETER", "code_information": [{"code": "50953", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SWALLOW (FEES) I&R", "code_information": [{"code": "92613", "type": "CPT"}], "standard_charges": [{"minimum": 40.47, "maximum": 40.47, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SWALLOW (FEES) VID", "code_information": [{"code": "92612", "type": "CPT"}], "standard_charges": [{"minimum": 135.77, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 176.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 139.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 135.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 155.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 155.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 155.27, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 176.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 176.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 176.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 176.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSTEAL IMPLANT", "code_information": [{"code": "D6012", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVAS ILIAC A DEVICE ADDON", "code_information": [{"code": "34808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 214.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 214.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 214.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 214.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 214.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC PROSTH DELAYED", "code_information": [{"code": "33886", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1003.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1003.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1003.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1003.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1003.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC PROSTH TAA ADD-ON", "code_information": [{"code": "33884", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 413.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 413.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 413.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 413.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 413.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR INCL SUBCL", "code_information": [{"code": "33880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1821.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1821.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1821.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1821.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1821.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR W/O SUBCL", "code_information": [{"code": "33881", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1574.4, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1574.4, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1574.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1574.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1574.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TEMPORY VESSEL OCCL", "code_information": [{"code": "61623", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 550.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 550.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 550.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 550.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 550.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 1 GRAFT", "code_information": [{"code": "34841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 2 GRAFT", "code_information": [{"code": "34842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 3 GRAFT", "code_information": [{"code": "34843", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 4 GRAFT", "code_information": [{"code": "34844", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [{"code": "266", "type": "MS-DRG"}], "standard_charges": [{"minimum": 203475.14, "maximum": 256406.13, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 203475.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 256406.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [{"code": "267", "type": "MS-DRG"}], "standard_charges": [{"minimum": 158068.08, "maximum": 199187.11, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 158068.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 199187.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES 1ST", "code_information": [{"code": "36482", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES SBSQ", "code_information": [{"code": "36483", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER 1ST VEIN", "code_information": [{"code": "36478", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER VEIN ADDON", "code_information": [{"code": "36479", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM 1ST VEIN", "code_information": [{"code": "36473", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM ADD-ON", "code_information": [{"code": "36474", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF 1ST VEIN", "code_information": [{"code": "36475", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF VEIN ADD-ON", "code_information": [{"code": "36476", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENFUVIRTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1324", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.68, "maximum": 0.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTACAPONE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304460", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENTACAPONE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304460", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST DISPR AG IA", "code_information": [{"code": "87336", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST GROUP IA", "code_information": [{"code": "87337", "type": "CPT"}, {"code": "7257339", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 368.0, "discounted_cash": 276.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERCOLYSIS SM BOWEL DBL CM", "code_information": [{"code": "74251", "type": "CPT"}, {"code": "4904251", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 467.04, "gross_charge": 2224.0, "discounted_cash": 1668.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 467.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 422.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 292.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 292.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 292.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 292.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 292.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY CADAVER DONOR", "code_information": [{"code": "44132", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY CONG ADD-ON", "code_information": [{"code": "44128", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 232.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 232.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 232.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 232.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 232.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY LIVE DONOR", "code_information": [{"code": "44133", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/O TAPER CONG", "code_information": [{"code": "44126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2213.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2213.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2213.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2213.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2213.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/TAPER CONG", "code_information": [{"code": "44127", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2571.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2571.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2571.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2571.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2571.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTEROSTOMAL THERAPY BY A RE", "code_information": [{"code": "S9474", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS AB/12", "code_information": [{"code": "86658", "type": "CPT"}, {"code": "7256668", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.43, "gross_charge": 75.0, "discounted_cash": 56.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.43, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS AB/15", "code_information": [{"code": "86658", "type": "CPT"}, {"code": "7256673", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.43, "gross_charge": 75.0, "discounted_cash": 56.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.43, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS AB/16", "code_information": [{"code": "86658", "type": "CPT"}, {"code": "7256675", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.43, "gross_charge": 239.0, "discounted_cash": 179.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.43, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS AB/17", "code_information": [{"code": "86658", "type": "CPT"}, {"code": "7256677", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.43, "gross_charge": 436.0, "discounted_cash": 327.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.43, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS AB/18", "code_information": [{"code": "86658", "type": "CPT"}, {"code": "7256678", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.43, "gross_charge": 75.0, "discounted_cash": 56.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS AB/4", "code_information": [{"code": "86658", "type": "CPT"}, {"code": "7256658", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.43, "gross_charge": 274.0, "discounted_cash": 205.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.43, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS AB/6", "code_information": [{"code": "86658", "type": "CPT"}, {"code": "7256660", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.43, "gross_charge": 337.0, "discounted_cash": 252.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE 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"plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1252.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1431.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1431.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1431.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EP POST DRUG INFUSION", "code_information": [{"code": "93623", "type": "CPT"}, {"code": "4610631", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "gross_charge": 1079.0, "discounted_cash": 809.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10612.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EP TEST AICD LEAD & GEN", "code_information": [{"code": "93641", "type": "CPT"}, {"code": "4610635", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "gross_charge": 9389.0, "discounted_cash": 7041.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10612.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPHYS EVAL ICDS SS", "code_information": [{"code": "577T", "type": "CPT"}], "standard_charges": [{"minimum": 7835.0, "maximum": 52472.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EPIDRM A-GRFT F/N/HF/G ADDL", "code_information": [{"code": "15116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDRM A-GRFT FACE/NCK/HF/G", "code_information": [{"code": "15115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3106.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT T/A/L ADD-ON", "code_information": [{"code": "15111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT TRNK/ARM/LEG", "code_information": [{"code": "15110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDURAL LYSIS MULT SESSIONS", "code_information": [{"code": "62263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDURAL LYSIS ON SINGLE DAY", "code_information": [{"code": "62264", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIFIX, INJ, 1MG", "code_information": [{"code": "Q4145", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EPILEPSY GEN SEQ ALYS PANEL", "code_information": [{"code": "81419", "type": "CPT"}], "standard_charges": [{"minimum": 2448.56, "maximum": 2448.56, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2448.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2448.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPINEPHRINE PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0165", "type": "HCPCS"}, {"code": "5320458", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.43, "maximum": 0.48, "gross_charge": 0.92, "discounted_cash": 0.69, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPINEPHRINE PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0165", "type": "HCPCS"}, {"code": "5320458", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.43, "maximum": 0.48, "gross_charge": 0.92, "discounted_cash": 0.69, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPINEPHRINEPER0.1MGPFSIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0165", "type": "HCPCS"}, {"code": "5320459", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.43, "maximum": 0.48, "gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPINEPHRINEPER0.1MGPFSIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0165", "type": "HCPCS"}, {"code": "5320459", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.43, "maximum": 0.48, "gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPISIOTOMY OR VAGINAL REPAIR", "code_information": [{"code": "59300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 80.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 80.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 80.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 80.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 80.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITH MCC", "code_information": [{"code": "150", "type": "MS-DRG"}], "standard_charges": [{"minimum": 44208.46, "maximum": 55708.63, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44208.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55708.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITHOUT MCC", "code_information": [{"code": "151", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24370.27, "maximum": 30709.83, "estimated_discounted_cash": 27506.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24370.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30709.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPLERENONE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304461", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EPLERENONE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304461", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EPOETIN ALFA, NON-ESRD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0885", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.69, "maximum": 8.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN BETA NON ESRD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0888", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.32, "maximum": 1.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN ESRD PER 100U IJ", "code_information": [{"code": "Q4081", "type": "HCPCS"}, {"code": "5320419", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1.05, "maximum": 1.05, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN ESRD PER 100U IJ", "code_information": [{"code": "Q4081", "type": "HCPCS"}, {"code": "5320419", "type": "CDM"}, {"code": "634", "type": "RC"}], "standard_charges": [{"minimum": 1.05, "maximum": 1.05, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN-EPBX ESRD PER 100U IJ", "code_information": [{"code": "Q5105", "type": "HCPCS"}, {"code": "5320471", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.71, "maximum": 0.79, "gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN-EPBX ESRD PER 100U IJ", "code_information": [{"code": "Q5105", "type": "HCPCS"}, {"code": "5320471", "type": "CDM"}, {"code": "634", "type": "RC"}], "standard_charges": [{"minimum": 0.71, "maximum": 0.79, "gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN-EPBX NON-ESRD 1000U IJ", "code_information": [{"code": "Q5106", "type": "HCPCS"}, {"code": "5320472", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 7.07, "maximum": 7.85, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN-EPBX NON-ESRD 1000U IJ", "code_information": [{"code": "Q5106", "type": "HCPCS"}, {"code": "5320472", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 7.07, "maximum": 7.85, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOPROSTENOL DILUTANT", "code_information": [{"code": "S0155", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.88, "maximum": 16.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR VIRUS EA AB/2", "code_information": [{"code": "86663", "type": "CPT"}, {"code": "7259433", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.9, "gross_charge": 424.0, "discounted_cash": 318.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR VIRUS NA AB", "code_information": [{"code": "86664", "type": "CPT"}, {"code": "7256663", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 78.04, "gross_charge": 88.0, "discounted_cash": 66.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 78.04, "methodology": "fee 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{"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR VIRUS VCA AB", "code_information": [{"code": "86665", "type": "CPT"}, {"code": "7256262", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.53, "gross_charge": 105.0, "discounted_cash": 78.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR VIRUS VCA AB/3", "code_information": [{"code": "86665", "type": "CPT"}, {"code": "7258677", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.53, "gross_charge": 305.0, "discounted_cash": 228.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.53, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR VIRUS VCA AB/5", "code_information": [{"code": "86665", "type": "CPT"}, {"code": "7259431", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.53, "gross_charge": 105.0, "discounted_cash": 78.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.53, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER REVISIT", "code_information": [{"code": "99281", "type": "CPT"}, {"code": "6100505", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 20.11, "maximum": 20.11, "gross_charge": 974.0, "discounted_cash": 730.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER URINE COLLECTION", "code_information": [{"code": "6104013", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 67.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ER VISIT LVL I", "code_information": [{"code": "99281", "type": "CPT"}, {"code": "6100510", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 20.11, "maximum": 20.11, "gross_charge": 974.0, "discounted_cash": 730.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER VISIT LVL II", "code_information": [{"code": "99282", "type": "CPT"}, {"code": "6100522", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 38.15, "maximum": 38.15, "gross_charge": 2064.0, "discounted_cash": 1548.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 38.15, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 38.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 38.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 38.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 38.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER VISIT LVL III", "code_information": [{"code": "99283", "type": "CPT"}, {"code": "6100524", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 61.34, "maximum": 61.34, "gross_charge": 3031.0, "discounted_cash": 2273.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.34, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 61.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 61.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 61.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 61.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER VISIT LVL IV", "code_information": [{"code": "99284", "type": "CPT"}, {"code": "6100526", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 113.24, "maximum": 113.24, "gross_charge": 4833.0, "discounted_cash": 3624.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 113.24, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 113.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 113.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 113.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 113.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER VISIT LVL V", "code_information": [{"code": "99285", "type": "CPT"}, {"code": "6100527", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 168.4, "maximum": 168.4, "gross_charge": 7168.0, "discounted_cash": 5376.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 168.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP BILIARY&PANCREATIC", "code_information": [{"code": "74330", "type": "CPT"}, {"code": "4904200", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 710.01, "gross_charge": 3381.0, "discounted_cash": 2535.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 710.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP DUCT STENT PLACEMENT", "code_information": [{"code": "43274", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 7736.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP EA DUCT/AMPULLA DILATE", "code_information": [{"code": "43277", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 6791.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP LESION ABLATE W/DILATE", "code_information": [{"code": "43278", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP LITHOTRIPSY CALCULI", "code_information": [{"code": "43265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 24307.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7467.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21875.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24307.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE DUCT CALCULI", "code_information": [{"code": "43264", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5611.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY DUCT", "code_information": [{"code": "43275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 6299.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY&ENDO", "code_information": [{"code": "C7560", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP RMV CALC PANCREATOSCOPY", "code_information": [{"code": "C7544", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP SPHINCTER PRESSURE MEAS", "code_information": [{"code": "43263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP STENT EXCHANGE W/DILATE", "code_information": [{"code": "43276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 7231.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP W/ PANCREATOSCOPY", "code_information": [{"code": "C7541", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP W/BX & PANCREATOSCOPY", "code_information": [{"code": "C7542", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP W/OPTICAL ENDOMICROSCPY", "code_information": [{"code": "397T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4347.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP W/OPTICAL ENDOMICROSCPY", "code_information": [{"code": "405U", "type": "CPT"}], "standard_charges": [{"minimum": 1770.48, "maximum": 1770.48, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1770.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1770.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/OTOMY, PANCREATOSCOPY", "code_information": [{"code": "C7543", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP W/SPECIMEN COLLECTION", "code_information": [{"code": "43260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 11355.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 936.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERGOCALCIFEROL 50000U CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304469", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ERGOCALCIFEROL 50000U CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304469", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ERGONOVINE MALEATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1330", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.9, "maximum": 5.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERIBULIN PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9179", "type": "HCPCS"}, {"code": "5320454", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 80.41, "maximum": 89.34, "gross_charge": 622.0, "discounted_cash": 466.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 80.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERIBULIN PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9179", "type": "HCPCS"}, {"code": "5320454", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 80.41, "maximum": 89.34, "gross_charge": 622.0, "discounted_cash": 466.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 80.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERWINAZE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9019", "type": "HCPCS"}], "standard_charges": [{"minimum": 413.57, "maximum": 459.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 413.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 459.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 459.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 459.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 459.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROMY200/5 100ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315146", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ERYTHROMY200/5 100ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315146", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ERYTHROMYC BASE 250 ECTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304651", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ERYTHROMYC BASE 250 ECTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304651", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ERYTHROMYC BASE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304647", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ERYTHROMYC BASE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304647", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ERYTHROMYC BASE 333 ECTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304649", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ERYTHROMYC BASE 333 ECTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304649", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ERYTHROPOIETIN", "code_information": [{"code": "82668", "type": "CPT"}, {"code": "7252668", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 95.85, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 95.85, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.26, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESCHAROTOMY ADDL INCISION", "code_information": [{"code": "16036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESCITALOPRAM 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304665", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ESCITALOPRAM 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304665", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ESCITALOPRAM 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304664", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ESCITALOPRAM 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304664", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ESD ENDOSCOPY OR COLONOSCOPY", "code_information": [{"code": "C9779", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESKETAMINE, NASAL SPRAY", "code_information": [{"code": "S0013", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.29, "maximum": 16.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH BALLOON DISTENSION TST", "code_information": [{"code": "91040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 470.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 470.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 470.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 470.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 470.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH EGD DILATION <30 MM", "code_information": [{"code": "43249", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4968.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH ENDOSCOPY DILATION", "code_information": [{"code": "43226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY LAP", "code_information": [{"code": "43327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY THOR", "code_information": [{"code": "43328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCT TST", "code_information": [{"code": "91037", "type": "CPT"}, {"code": "5071251", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "gross_charge": 4859.0, "discounted_cash": 3644.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 184.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 184.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 184.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 184.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 184.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCT TST>1H", "code_information": [{"code": "91038", "type": "CPT"}, {"code": "5071252", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "gross_charge": 4859.0, "discounted_cash": 3644.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 157.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 157.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 157.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 157.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 157.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH LENGTHENING", "code_information": [{"code": "43338", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH MOTILITY STUDY", "code_information": [{"code": "91010", "type": "CPT"}, {"code": "5071062", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "gross_charge": 4859.0, "discounted_cash": 3644.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 232.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 232.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 232.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 232.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 232.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH PH TST W NSL CATH", "code_information": [{"code": "91034", "type": "CPT"}, {"code": "5071253", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "gross_charge": 4859.0, "discounted_cash": 3644.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 252.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 252.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 252.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 252.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 252.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SCLEROSIS INJ", "code_information": [{"code": "43204", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SUBMUCOUS INJ", "code_information": [{"code": "43201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAG MUC INTEG W/ESO EGD", "code_information": [{"code": "C9777", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4326.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4203.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4806.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4806.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4806.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL MOTILITY STUDY", "code_information": [{"code": "78258", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 455.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 455.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 229.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1288.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1252.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1431.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1431.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1431.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1288.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1252.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1431.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1431.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1431.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [{"code": "391", "type": "MS-DRG"}], "standard_charges": [{"minimum": 42110.1, "maximum": 53064.4, "estimated_discounted_cash": 73714.47, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42110.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 53064.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [{"code": "392", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25884.28, "maximum": 32617.68, "estimated_discounted_cash": 55567.14, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25884.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32617.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY ABDOMINAL", "code_information": [{"code": "43330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1214.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1214.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1214.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1214.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1214.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY THORACIC", "code_information": [{"code": "43331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1322.56, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1322.56, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1322.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1322.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1322.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOPLASTY CONGENITAL", "code_information": [{"code": "43313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2644.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2644.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2644.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2644.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2644.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSC DILATE BALLOON 30", "code_information": [{"code": "43214", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSC FLEX TRNSN BIOPSY", "code_information": [{"code": "43198", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP MUCOSAL RESECT", "code_information": [{"code": "43211", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP STENT PLACEMENT", "code_information": [{"code": "43212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP ULTRASOUND EXAM", "code_information": [{"code": "43231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY BALLOON <30MM", "code_information": [{"code": "43220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY CONTROL BLEED", "code_information": [{"code": "43227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX BIOPSY", "code_information": [{"code": "43202", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX DX BRUSH", "code_information": [{"code": "43197", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX REMOVE FB", "code_information": [{"code": "43215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEXIBLE BRUSH", "code_information": [{"code": "43200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8487.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY LESION ABLATE", "code_information": [{"code": "43229", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 9151.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY LESION REMOVAL", "code_information": [{"code": "43216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RETRO BALLOON", "code_information": [{"code": "43213", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID BALLOON", "code_information": [{"code": "43195", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRNSO", "code_information": [{"code": "43180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRNSO DX", "code_information": [{"code": "43191", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY SNARE LES REMV", "code_information": [{"code": "43217", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY W/US NEEDLE BX", "code_information": [{"code": "43232", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP GUIDE WIRE DILAT", "code_information": [{"code": "43196", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO BIOPSY", "code_information": [{"code": "43193", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO INJECT", "code_information": [{"code": "43192", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO REM FB", "code_information": [{"code": "43194", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS ENDOSCOPY/LIGATION", "code_information": [{"code": "43205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS IMAGE CAP PROC", "code_information": [{"code": "91111", "type": "CPT"}, {"code": "5071111", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1186.14, "gross_charge": 6040.0, "discounted_cash": 4530.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 902.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1067.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1037.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1186.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1186.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1186.14, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 902.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 902.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 902.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 902.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS W/DBL CONTRAST", "code_information": [{"code": "74221", "type": "CPT"}, {"code": "4904221", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 178.55, "gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 33.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHGL MOTIL W/STIM/PERFUS", "code_information": [{"code": "91013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESPHG DSTL 2/3 W/LAPS MOBLJ", "code_information": [{"code": "43287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESPHG THRSC MOBLJ", "code_information": [{"code": "43288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESPHG TOT W/LAPS MOBLJ", "code_information": [{"code": "43286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESPHG TOT W/THRCM", "code_information": [{"code": "43112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2625.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2625.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2625.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2625.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2625.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD DEMO BUNDLE LEVEL I", "code_information": [{"code": "G9013", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD DEMO BUNDLE-LEVEL II", "code_information": [{"code": "G9014", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO <2YRS", "code_information": [{"code": "90953", "type": "CPT"}], "standard_charges": [{"minimum": 900.82, "maximum": 1030.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 927.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 900.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1030.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1030.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1030.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO AORTA", "code_information": [{"code": "36160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 670.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 670.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 670.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 670.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 670.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO ARTERY", "code_information": [{"code": "36100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 647.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 647.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 647.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 647.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 647.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1483.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1483.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1483.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1483.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1483.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 828.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 828.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 828.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 828.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 828.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62192", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 902.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 902.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 902.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 902.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 902.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1290.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1290.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1290.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1290.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1290.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 960.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 960.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 960.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 960.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 960.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62223", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 973.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 973.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 973.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 973.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 973.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL", "code_information": [{"code": "82670", "type": "CPT"}, {"code": "4102670", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 142.5, "gross_charge": 564.0, "discounted_cash": 423.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL", "code_information": [{"code": "82670", "type": "CPT"}, {"code": "7252670", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 142.5, "gross_charge": 174.0, "discounted_cash": 130.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 39.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304674", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ESTRADIOL 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304674", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ESTRIOL", "code_information": [{"code": "82677", "type": "CPT"}, {"code": "7252677", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 123.33, "gross_charge": 153.0, "discounted_cash": 114.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 123.33, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROGEN CONJ PER25MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1410", "type": "HCPCS"}, {"code": "5320542", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 352.85, "maximum": 392.06, "gross_charge": 514.0, "discounted_cash": 385.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 352.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 392.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROGEN CONJ PER25MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1410", "type": "HCPCS"}, {"code": "5320542", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 352.85, "maximum": 392.06, "gross_charge": 514.0, "discounted_cash": 385.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 352.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 392.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROGENS FRACTIONATED", "code_information": [{"code": "82671", "type": "CPT"}, {"code": "7252671", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 164.72, "gross_charge": 554.0, "discounted_cash": 415.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 164.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROGENS TOTAL", "code_information": [{"code": "82672", "type": "CPT"}, {"code": "7252672", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 110.6, "gross_charge": 258.0, "discounted_cash": 193.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.3, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRONE/2", "code_information": [{"code": "82679", "type": "CPT"}, {"code": "7252679", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 127.31, "gross_charge": 450.0, "discounted_cash": 337.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 127.31, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG 1ST WND", "code_information": [{"code": "512T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG EA ADDL", "code_information": [{"code": "513T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESW MUSCSKEL SYS NOS", "code_information": [{"code": "101T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESW PHY ANES LAT HMRL EPCNDL", "code_information": [{"code": "102T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESWL FOR GALLSTONES", "code_information": [{"code": "S9034", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 24307.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21875.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24307.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESZOPICLONE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304720", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ESZOPICLONE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304720", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ETANERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1438", "type": "HCPCS"}], "standard_charges": [{"minimum": 1046.21, "maximum": 1162.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1046.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1162.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1162.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1162.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1162.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETH ESTR AND ETON MONTHLY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7295", "type": "HCPCS"}], "standard_charges": [{"minimum": 116.21, "maximum": 129.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 116.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 129.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 129.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 129.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 129.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHACRYNIC ACID 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304743", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHACRYNIC ACID 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304743", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHAMBUTOL 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304770", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHAMBUTOL 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304770", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHAMBUTOL 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304774", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHAMBUTOL 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304774", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHANOLAMINE PER100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1430", "type": "HCPCS"}, {"code": "5320560", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 458.06, "maximum": 508.96, "gross_charge": 2500.0, "discounted_cash": 1875.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 458.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 508.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 508.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 508.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 508.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHANOLAMINE PER100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1430", "type": "HCPCS"}, {"code": "5320560", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 458.06, "maximum": 508.96, "gross_charge": 2500.0, "discounted_cash": 1875.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 458.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 508.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 508.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 508.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 508.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHOSUXAMIDE 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304859", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHOSUXAMIDE 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304859", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHOSUXIMIDE", "code_information": [{"code": "80168", "type": "CPT"}, {"code": "7252692", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.33, "gross_charge": 94.0, "discounted_cash": 70.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHYLENE GLYCOL", "code_information": [{"code": "82693", "type": "CPT"}, {"code": "7002691", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 75.99, "gross_charge": 384.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 75.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.82, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETIDRONATE DISODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1436", "type": "HCPCS"}], "standard_charges": [{"minimum": 64.27, "maximum": 71.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 64.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 71.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 71.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 71.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 71.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETONOGESTREL IMPLANT SYSTEM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7307", "type": "HCPCS"}], "standard_charges": [{"minimum": 1246.21, "maximum": 1384.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1246.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1384.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1384.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1384.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1384.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EUFLEXXA INJ PER DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7323", "type": "HCPCS"}], "standard_charges": [{"minimum": 101.21, "maximum": 112.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 101.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 112.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 112.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 112.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 112.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EUGLOBULIN LYSIS", "code_information": [{"code": "85360", "type": "CPT"}, {"code": "7255360", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 42.85, "gross_charge": 95.0, "discounted_cash": 71.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 42.85, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.74, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EV CATH DIR CHEM ABLTJ W/IMG", "code_information": [{"code": "524T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EV FEMPOP ARTL REVSC", "code_information": [{"code": "505T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVAC MEIBOMIAN GLND HEAT BI", "code_information": [{"code": "563T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVAC RPR A-BIILIAC NDGFT", "code_information": [{"code": "34705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVACUATE MOLE OF UTERUS", "code_information": [{"code": "59870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVAL ANTITACH PACEMAKER", "code_information": [{"code": "93724", "type": "CPT"}, {"code": "4613724", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 381.91, "maximum": 436.74, "gross_charge": 3092.0, "discounted_cash": 2319.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 387.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 393.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 381.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 436.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 436.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 436.74, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 387.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 387.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 387.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 387.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL ANTITACH PACEMAKER", "code_information": [{"code": "93724", "type": "CPT"}, {"code": "4613724", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 381.91, "maximum": 436.74, "gross_charge": 3092.0, "discounted_cash": 2319.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 387.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 393.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 381.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 436.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 436.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 436.74, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 387.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 387.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 387.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 387.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL AUD FUNCJ 1ST HOUR", "code_information": [{"code": "92626", "type": "CPT"}], "standard_charges": [{"minimum": 98.46, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 98.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 98.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 98.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 98.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 98.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL AUD FUNCJ EA ADDL 15", "code_information": [{"code": "92627", "type": "CPT"}], "standard_charges": [{"minimum": 23.61, "maximum": 23.61, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL ON FOOT DOCUMENTED", "code_information": [{"code": "G8410", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAL ON FOOT NOT PERFORMED", "code_information": [{"code": "G8415", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAL RISK VTE CARD 30D PRIOR", "code_information": [{"code": "G9298", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVAL SELF-ASSESS DEPRESSION", "code_information": [{"code": "S3005", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATE SPEECH PRODUCTION", "code_information": [{"code": "92522", "type": "CPT"}], "standard_charges": [{"minimum": 183.99, "maximum": 210.4, "estimated_discounted_cash": 1844.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 189.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 183.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 210.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 210.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 210.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATE SWALLOWING FUNCTION", "code_information": [{"code": "92610", "type": "CPT"}], "standard_charges": [{"minimum": 120.69, "maximum": 165.52, "estimated_discounted_cash": 1878.94, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 120.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 144.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 120.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 120.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 120.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 120.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION BY OCULARIST", "code_information": [{"code": "S9150", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATION CERVICAL MUCUS", "code_information": [{"code": "89330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 50.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.83, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION FOR WHEELCHAIR", "code_information": [{"code": "G9156", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF SPEECH FLUENCY", "code_information": [{"code": "92521", "type": "CPT"}], "standard_charges": [{"minimum": 228.42, "maximum": 261.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 235.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 228.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 261.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 261.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 261.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC PRLNG ADMN RX AGNT 1ST", "code_information": [{"code": "61650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC PRLNG ADMN RX AGNT ADD", "code_information": [{"code": "61651", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT", "code_information": [{"code": "34701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT RPT", "code_information": [{"code": "34702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-BIILIAC RPT", "code_information": [{"code": "34706", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-ILIAC NDGFT", "code_information": [{"code": "34717", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT", "code_information": [{"code": "34703", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT RPT", "code_information": [{"code": "34704", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC NDGFT", "code_information": [{"code": "34707", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC RPT", "code_information": [{"code": "34708", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR N/A A-ILIAC NDGFT", "code_information": [{"code": "34718", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC ST RPR THRC/AA ACRS BR", "code_information": [{"code": "33894", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC ST RPR THRC/AA X CRSG", "code_information": [{"code": "33895", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC VEN ARTLZ TIBL/PRNL VN", "code_information": [{"code": "620T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVENT MONITOR RECORDING", "code_information": [{"code": "93270", "type": "CPT"}, {"code": "4603270", "type": "CDM"}, {"code": "731", "type": "RC"}], "standard_charges": [{"minimum": 37.38, "maximum": 57.87, "gross_charge": 2252.0, "discounted_cash": 1689.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVEROLIMUS", "code_information": [{"code": "80169", "type": "CPT"}, {"code": "7252532", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 70.15, "gross_charge": 134.0, "discounted_cash": 100.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 70.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST LIMITED", "code_information": [{"code": "92587", "type": "CPT"}], "standard_charges": [{"minimum": 343.64, "maximum": 392.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST QUAL", "code_information": [{"code": "92558", "type": "CPT"}], "standard_charges": [{"minimum": 17.42, "maximum": 19.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TST COMPLETE", "code_information": [{"code": "92588", "type": "CPT"}], "standard_charges": [{"minimum": 343.64, "maximum": 392.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX ARM/ELBOW TUM DEEP 5 CM/>", "code_information": [{"code": "24073", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EX ARM/ELBOW TUM DEEP < 5 CM", "code_information": [{"code": "24076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EX FOR NONSPEECH DEV RX ADD", "code_information": [{"code": "92618", "type": "CPT"}], "standard_charges": [{"minimum": 65.41, "maximum": 74.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 67.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 65.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR NONSPEECH DEVICE RX", "code_information": [{"code": "92605", "type": "CPT"}], "standard_charges": [{"minimum": 176.11, "maximum": 201.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 181.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 176.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 201.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 201.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 201.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR SPEECH DEVICE RX 1HR", "code_information": [{"code": "92607", "type": "CPT"}], "standard_charges": [{"minimum": 179.17, "maximum": 302.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 179.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 271.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 264.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 302.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 302.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 302.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 179.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 179.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 179.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 179.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR SPEECH DEVICE RX ADDL", "code_information": [{"code": "92608", "type": "CPT"}], "standard_charges": [{"minimum": 34.64, "maximum": 120.78, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 34.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 108.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 105.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 120.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 120.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 120.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 34.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 34.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 34.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 34.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM MACRO ARTHROPOD", "code_information": [{"code": "87168", "type": "CPT"}, {"code": "4107141", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.75, "gross_charge": 123.0, "discounted_cash": 92.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM MACRO ARTHROPOD", "code_information": [{"code": "87168", "type": "CPT"}, {"code": "7257168", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.75, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM MACRO PARASITE", "code_information": [{"code": "87169", "type": "CPT"}, {"code": "4107142", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.75, "gross_charge": 134.0, "discounted_cash": 100.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM MACRO PARASITE", "code_information": [{"code": "87169", "type": "CPT"}, {"code": "7257174", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.75, "gross_charge": 25.0, "discounted_cash": 18.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM OF CERVIX W/SCOPE", "code_information": [{"code": "57452", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7209.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM OF VAGINA W/SCOPE", "code_information": [{"code": "57420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM OF VULVA W/SCOPE", "code_information": [{"code": "56820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM/BIOPSY OF VAG W/SCOPE", "code_information": [{"code": "57421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 63.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 63.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 63.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 63.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 63.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM/BIOPSY OF VULVA W/SCOPE", "code_information": [{"code": "56821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABD LES SC 3 CM/>", "code_information": [{"code": "22903", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 13915.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABD LES SC < 3 CM", "code_information": [{"code": "22902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM 5 CM OR LESS", "code_information": [{"code": "49203", "type": "CPT"}], "standard_charges": [{"minimum": 1103.48, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1103.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1103.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1103.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1103.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1103.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM OVER 10 CM", "code_information": [{"code": "49205", "type": "CPT"}], "standard_charges": [{"minimum": 1602.6, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1602.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1602.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1602.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1602.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1602.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM OVER 5 CM", "code_information": [{"code": "49204", "type": "CPT"}], "standard_charges": [{"minimum": 1402.53, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1402.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1402.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1402.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1402.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1402.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC ABDL TUM DEEP 5 CM/>", "code_information": [{"code": "22901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABDL TUM DEEP < 5 CM", "code_information": [{"code": "22900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ARM/ELBOW LES SC 3 CM/>", "code_information": [{"code": "24071", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 11928.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ARM/ELBOW LES SC < 3 CM", "code_information": [{"code": "24075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10411.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BACK LES SC 3 CM/>", "code_information": [{"code": "21931", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 21001.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BACK LES SC < 3 CM", "code_information": [{"code": "21930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BACK TUM DEEP 5 CM/>", "code_information": [{"code": "21933", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BACK TUM DEEP < 5 CM", "code_information": [{"code": "21932", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BIOPSY OF SALIV GLANDS", "code_information": [{"code": "D7284", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/LYMPHADEC", "code_information": [{"code": "21603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/O LYMPHADEC", "code_information": [{"code": "21602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC CHEST WALL TUMOR W/RIBS", "code_information": [{"code": "21601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 0.5CM<", "code_information": [{"code": "11640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 0.6-1", "code_information": [{"code": "11641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 1.1-2", "code_information": [{"code": "11642", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 136.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 136.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 136.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 136.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 136.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 2.1-3", "code_information": [{"code": "11643", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 148.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 148.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 148.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 148.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 148.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 3.1-4", "code_information": [{"code": "11644", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG >4 CM", "code_information": [{"code": "11646", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE LES SBQ 2 CM/>", "code_information": [{"code": "21012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE LES SC <2 CM", "code_information": [{"code": "21011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE TUM DEEP 2 CM/>", "code_information": [{"code": "21014", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 23828.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE TUM DEEP < 2 CM", "code_information": [{"code": "21013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 0.5 CM/<", "code_information": [{"code": "11440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 77.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 77.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 77.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 77.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 77.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 0.6-1 CM", "code_information": [{"code": "11441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15367.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 86.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 86.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 86.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 86.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 86.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 1.1-2 CM", "code_information": [{"code": "11442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 21860.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 2.1-3 CM", "code_information": [{"code": "11443", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 11917.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 106.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 106.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 106.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 106.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 106.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 3.1-4 CM", "code_information": [{"code": "11444", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG >4 CM", "code_information": [{"code": "11446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM DEEP <1.5CM", "code_information": [{"code": "28045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM DEP 1.5CM/>", "code_information": [{"code": "28041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM SC 1.5 CM/>", "code_information": [{"code": "28039", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM SC < 1.5 CM", "code_information": [{"code": "28043", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM LES SC 3 CM/>", "code_information": [{"code": "25071", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 6957.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM LES SC < 3 CM", "code_information": [{"code": "25075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10930.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM TUM DEEP 3 CM/>", "code_information": [{"code": "25073", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 10930.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM TUM DEEP < 3 CM", "code_information": [{"code": "25076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 0.5/<", "code_information": [{"code": "11420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 0.6-1", "code_information": [{"code": "11421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 78.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 78.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 78.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 78.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 78.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 1.1-2", "code_information": [{"code": "11422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 20574.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 2.1-3", "code_information": [{"code": "11423", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17600.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 96.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 96.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 96.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 96.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 96.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 3.1-4", "code_information": [{"code": "11424", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17031.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG >4 CM", "code_information": [{"code": "11426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 19946.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP MAL+MARG 0.5/<", "code_information": [{"code": "11620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 100.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 100.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 100.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 100.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 100.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HAND LES SC 1.5 CM/>", "code_information": [{"code": "26111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HAND LES SC < 1.5 CM", "code_information": [{"code": "26115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HAND TUM DEEP 1.5 CM/>", "code_information": [{"code": "26113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HAND TUM DEEP < 1.5 CM", "code_information": [{"code": "26116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HIP PELVIS LES SC 3 CM/>", "code_information": [{"code": "27043", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 23828.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELV TUM DEEP 5 CM/>", "code_information": [{"code": "27045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELV TUM DEEP < 5 CM", "code_information": [{"code": "27048", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELVIS LES SC < 3 CM", "code_information": [{"code": "27047", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE LES SC 3 CM/>", "code_information": [{"code": "27632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 15894.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM < 3 CM", "code_information": [{"code": "27618", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM DEEP <5 CM", "code_information": [{"code": "27619", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM DEP 5 CM/>", "code_information": [{"code": "27634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 41952.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NECK LES SC 3 CM/>", "code_information": [{"code": "21552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 10165.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NECK LES SC < 3 CM", "code_information": [{"code": "21555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10287.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NECK TUM DEEP 5 CM/>", "code_information": [{"code": "21554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NECK TUM DEEP < 5 CM", "code_information": [{"code": "21556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14066.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NEUROMA W/ IMPLNT NV END", "code_information": [{"code": "C7551", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC RECT TUM TRANSANAL FULL", "code_information": [{"code": "45172", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC RECT TUM TRANSANAL PART", "code_information": [{"code": "45171", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 23828.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC RECTAL TUMOR ENDOSCOPIC", "code_information": [{"code": "184T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 0.6-1", "code_information": [{"code": "11621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 1.1-2", "code_information": [{"code": "11622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 126.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 126.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 126.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 126.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 126.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 2.1-3", "code_information": [{"code": "11623", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 136.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 136.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 136.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 136.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 136.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 3.1-4", "code_information": [{"code": "11624", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG >4 CM", "code_information": [{"code": "11626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER LES SC 3 CM/>", "code_information": [{"code": "23071", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 15890.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER LES SC < 3 CM", "code_information": [{"code": "23075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER TUM DEEP 5 CM/>", "code_information": [{"code": "23073", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER TUM DEEP < 5 CM", "code_information": [{"code": "23076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKIN ABD", "code_information": [{"code": "15830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 54741.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKIN ABD ADD-ON", "code_information": [{"code": "15847", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN H/P/P/U COMPLEX", "code_information": [{"code": "11471", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN H/P/P/U SMPL/NTRM", "code_information": [{"code": "11470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT AX COMPLEX", "code_information": [{"code": "11451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT AX SMPL/NTRM", "code_information": [{"code": "11450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT ING COMPLEX", "code_information": [{"code": "11463", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT ING SMPL/NTRM", "code_information": [{"code": "11462", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE LES SC 3 CM/>", "code_information": [{"code": "27337", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 11423.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE LES SC < 3 CM", "code_information": [{"code": "27327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE TUM DEEP <5CM", "code_information": [{"code": "27328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE TUM DEP 5CM/>", "code_information": [{"code": "27339", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 0.5 CM<", "code_information": [{"code": "11400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 20574.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 71.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 71.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 71.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 71.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 71.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 0.6-1 CM", "code_information": [{"code": "11401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 77.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 77.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 77.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 77.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 77.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 1.1-2 CM", "code_information": [{"code": "11402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 23618.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 84.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 84.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 84.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 84.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 84.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 2.1-3CM", "code_information": [{"code": "11403", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 13734.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 90.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 90.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 90.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 90.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 90.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 3.1-4 CM", "code_information": [{"code": "11404", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17924.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG >4.0 CM", "code_information": [{"code": "11406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 13987.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 0.5 CM/<", "code_information": [{"code": "11600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 98.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 98.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 98.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 98.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 98.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 0.6-1 CM", "code_information": [{"code": "11601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 112.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 112.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 112.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 112.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 112.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 1.1-2 CM", "code_information": [{"code": "11602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 2.1-3 CM", "code_information": [{"code": "11603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10930.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 130.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 130.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 130.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 130.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 130.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 3.1-4 CM", "code_information": [{"code": "11604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG >4 CM", "code_information": [{"code": "11606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/B9 TUM RDS", "code_information": [{"code": "24120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM HUM AGRF", "code_information": [{"code": "24115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM HUM ALGR", "code_information": [{"code": "24116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM RDS AGRF", "code_information": [{"code": "24125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM RDS ALGR", "code_information": [{"code": "24126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CURTG B1 CST/B9 TUM HUM", "code_information": [{"code": "24110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCAVATE TOOTH NON-RESTORABL", "code_information": [{"code": "D2989", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCELLAGEN, 0.1 CC", "code_information": [{"code": "Q4149", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCERCIS TST BRONCHSPASM W/EKG", "code_information": [{"code": "94617", "type": "CPT"}, {"code": "5504617", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 145.03, "maximum": 165.85, "gross_charge": 1017.0, "discounted_cash": 762.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCH ABSC/CYST DRN CATH", "code_information": [{"code": "4919423", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6869.0, "discounted_cash": 5151.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCH ABSC/CYST DRN CATH", "code_information": [{"code": "5059423", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6869.0, "discounted_cash": 5151.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCH BIL CATH W/ RMV CALCULI", "code_information": [{"code": "C7545", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCH NEPH CATH W/ DIL STRIC", "code_information": [{"code": "C7548", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHANGE BILIARY DRG CATH", "code_information": [{"code": "47536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHANGE DRAINAGE CATHETER", "code_information": [{"code": "49423", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 686.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHANGE LENS PROSTHESIS", "code_information": [{"code": "66986", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13866.0, "estimated_discounted_cash": 21121.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12478.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13866.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHANGE NEPHROSTOMY CATH", "code_information": [{"code": "50435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7443.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS 250-500", "code_information": [{"code": "96921", "type": "CPT"}], "standard_charges": [{"minimum": 177.55, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 177.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 247.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 240.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 177.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 177.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 177.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 177.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS<250SQCM", "code_information": [{"code": "96920", "type": "CPT"}], "standard_charges": [{"minimum": 180.71, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 247.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 240.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS>500SQCM", "code_information": [{"code": "96922", "type": "CPT"}], "standard_charges": [{"minimum": 259.77, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 440.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 427.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 489.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 489.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 489.19, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIS UPPR JAW CYST W/REPAIR", "code_information": [{"code": "21049", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1235.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1235.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1235.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1235.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1235.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE ANAL EXT TAG/PAPILLA", "code_information": [{"code": "46220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15890.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE BREAST DUCT FISTULA", "code_information": [{"code": "19112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EPIPHYSEAL BAR", "code_information": [{"code": "20150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN & TISSUE", "code_information": [{"code": "15839", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN ARM/HAND", "code_information": [{"code": "15837", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN FAT PAD", "code_information": [{"code": "15838", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 192.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN ARM", "code_information": [{"code": "15836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 418.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 418.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 418.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 418.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 418.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN BUTTCK", "code_information": [{"code": "15835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN HIP", "code_information": [{"code": "15834", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN LEG", "code_information": [{"code": "15833", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN THIGH", "code_information": [{"code": "15832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 56368.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE FOOT TENDON SHEATH", "code_information": [{"code": "28086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE FOOT TENDON SHEATH", "code_information": [{"code": "28088", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE ILEOANAL RESERVIOR", "code_information": [{"code": "45136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1693.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1693.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1693.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1693.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1693.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INFERIOR TURBINATE", "code_information": [{"code": "30130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8080.84, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTESTINE LESION(S)", "code_information": [{"code": "44110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 770.27, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 770.27, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 770.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 770.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 770.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRASPINL LESION CRV", "code_information": [{"code": "63265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1565.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1565.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1565.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1565.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1565.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION CRVL", "code_information": [{"code": "63270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1927.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1927.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1927.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1927.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1927.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION LMBR", "code_information": [{"code": "63267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1301.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1301.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1301.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1301.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1301.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION LMBR", "code_information": [{"code": "63272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1787.29, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1787.29, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1787.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1787.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1787.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION SCRL", "code_information": [{"code": "63268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1287.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1287.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1287.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1287.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1287.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION SCRL", "code_information": [{"code": "63273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1726.04, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1726.04, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1726.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1726.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1726.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION THRC", "code_information": [{"code": "63266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1611.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1611.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1611.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1611.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1611.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION THRC", "code_information": [{"code": "63271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1935.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1935.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1935.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1935.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1935.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE LESION TESTIS", "code_information": [{"code": "54512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE LIP OR CHEEK FOLD", "code_information": [{"code": "40819", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE LWR JAW CYST W/REPAIR", "code_information": [{"code": "21047", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE MANDIBLE LESION", "code_information": [{"code": "21040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE MAX/ZYGOMA B9 TUMOR", "code_information": [{"code": "21030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 248.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 248.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 248.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 248.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 248.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE MAX/ZYGOMA MAL TUMOR", "code_information": [{"code": "21034", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE ORAL MUCOSA FOR GRAFT", "code_information": [{"code": "40818", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "estimated_discounted_cash": 59622.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1354.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1354.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1354.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1354.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1354.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PHARYNX LESION", "code_information": [{"code": "42808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE SACRAL SPINE TUMOR", "code_information": [{"code": "49215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2032.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2032.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2032.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2032.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2032.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE SUBLINGUAL GLAND", "code_information": [{"code": "42450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE SUBMAXILLARY GLAND", "code_information": [{"code": "42440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE TENDON FOREARM/WRIST", "code_information": [{"code": "25109", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE WRIST TENDON SHEATH", "code_information": [{"code": "25118", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE/REPAIR MOUTH LESION", "code_information": [{"code": "40812", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10930.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 151.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 151.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 151.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 151.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 151.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE/REPAIR MOUTH LESION", "code_information": [{"code": "40814", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION ADDL BREAST LESION", "code_information": [{"code": "19126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION COMPL", "code_information": [{"code": "D7412", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION>1.25C", "code_information": [{"code": "D7411", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BREAST LESION", "code_information": [{"code": "19125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 36844.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION CONSTRICTING TISSUE", "code_information": [{"code": "26596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT ABDOMEN", "code_information": [{"code": "35907", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1992.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1992.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1992.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1992.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1992.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT EXTREMITY", "code_information": [{"code": "35903", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 608.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 608.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 608.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 608.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 608.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT NECK", "code_information": [{"code": "35901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 536.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 536.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 536.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 536.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 536.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT THORAX", "code_information": [{"code": "35905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1821.78, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1821.78, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1821.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1821.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1821.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION GUM EACH QUADRANT", "code_information": [{"code": "41820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION HAND/FINGER TENDON", "code_information": [{"code": "26415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42104", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 112.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 112.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 112.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 112.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 112.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 21860.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 140.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 140.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 140.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 140.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 140.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LES COMPLICAT", "code_information": [{"code": "D7415", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LESION<=1.25C", "code_information": [{"code": "D7413", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LESION>1.25CM", "code_information": [{"code": "D7414", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ANAL LESION(S)", "code_information": [{"code": "46922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 21634.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT CYST", "code_information": [{"code": "47715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1198.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1198.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1198.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1198.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1198.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT TUMOR", "code_information": [{"code": "47711", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1421.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1421.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1421.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1421.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1421.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT TUMOR", "code_information": [{"code": "47712", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1818.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1818.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1818.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1818.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1818.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BONE LOWER JAW", "code_information": [{"code": "21025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL LESION(S)", "code_information": [{"code": "44111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 898.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 898.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 898.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 898.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 898.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL POUCH", "code_information": [{"code": "44800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 702.12, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 702.12, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 702.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 702.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 702.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BRAIN TUMOR", "code_information": [{"code": "61545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2980.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2980.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2980.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2980.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2980.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ESOPHAGUS LESION", "code_information": [{"code": "43100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 617.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 617.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 617.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 617.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 617.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ESOPHAGUS LESION", "code_information": [{"code": "43101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 996.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 996.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 996.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 996.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 996.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF FACIAL BONE(S)", "code_information": [{"code": "21026", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM FLAP", "code_information": [{"code": "41821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 159.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 159.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 159.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 159.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 159.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41823", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 221.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 221.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 221.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 221.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 221.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41826", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 138.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 138.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 138.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 138.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 138.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41827", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41828", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 144.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 144.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 144.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 144.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 144.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HIP JOINT/MUSCLE", "code_information": [{"code": "27036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 988.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 988.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 988.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 988.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 988.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LINGUAL TONSIL", "code_information": [{"code": "42870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MESENTERY LESION", "code_information": [{"code": "44820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 767.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 767.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 767.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 767.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 767.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "40810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 120.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 120.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 120.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 120.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 120.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "40816", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "41116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NAIL FOLD TOE", "code_information": [{"code": "11765", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NECK CYST", "code_information": [{"code": "42810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NECK CYST", "code_information": [{"code": "42815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF PENIS LESION(S)", "code_information": [{"code": "54060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL LESION", "code_information": [{"code": "45160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 990.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 990.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 990.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 990.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 990.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1218.71, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1218.71, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1218.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1218.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1218.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL STRICTURE", "code_information": [{"code": "45150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SALIVARY CYST", "code_information": [{"code": "42408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SALIVARY GLAND", "code_information": [{"code": "D7981", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL TUMOR", "code_information": [{"code": "61563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1775.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1775.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1775.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1775.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1775.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL TUMOR", "code_information": [{"code": "61564", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2277.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2277.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2277.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2277.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2277.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL/SUTURES", "code_information": [{"code": "61558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1605.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1605.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1605.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1605.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1605.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL/SUTURES", "code_information": [{"code": "61559", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2277.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2277.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2277.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2277.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2277.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 893.63, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 893.63, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 893.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 893.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 893.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1108.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1108.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1108.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1108.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1108.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE FOLD", "code_information": [{"code": "41115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 137.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 137.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 137.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 137.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 137.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41114", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONSIL TAGS", "code_information": [{"code": "42860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF UMBILICUS", "code_information": [{"code": "49250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF UVULA", "code_information": [{"code": "42140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5957.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OLECRANON BURSA", "code_information": [{"code": "24105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION PERICORONAL GINGIVA", "code_information": [{"code": "D7971", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION RADIAL HEAD", "code_information": [{"code": "24130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPEN ANY METHOD", "code_information": [{"code": "33267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPN OTH PX ANY METH", "code_information": [{"code": "33268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCL LAA THRSCP ANY METHOD", "code_information": [{"code": "33269", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXEMESTANE, 25 MG", "code_information": [{"code": "S0156", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.71, "maximum": 1.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXERCISE CLASS", "code_information": [{"code": "S9451", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXERCISE W/HEMODYNAMIC MEAS", "code_information": [{"code": "93464", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXERCSE TST BRONCHSPASM WO/EKG", "code_information": [{"code": "94619", "type": "CPT"}, {"code": "5504619", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 75.35, "maximum": 86.17, "gross_charge": 439.0, "discounted_cash": 329.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 77.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 75.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 86.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 86.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 86.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXFOLIATIVE CYTOLOG COLLECT", "code_information": [{"code": "D7287", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXFX HOF CON ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.08, "maximum": 409.08, "gross_charge": 1948.0, "discounted_cash": 1461.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 409.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS", "code_information": [{"code": "94690", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 73.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 73.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 73.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 73.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 73.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 73.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS O2", "code_information": [{"code": "94680", "type": "CPT"}], "standard_charges": [{"minimum": 78.18, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 78.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 78.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 78.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 78.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 78.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS O2/CO2", "code_information": [{"code": "94681", "type": "CPT"}], "standard_charges": [{"minimum": 93.12, "maximum": 392.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 93.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 93.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 93.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 93.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 93.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED BREATH CONDENSATE", "code_information": [{"code": "83987", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED NITRIC OXIDE MEAS", "code_information": [{"code": "95012", "type": "CPT"}], "standard_charges": [{"minimum": 22.85, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOME RE-EVALUATION", "code_information": [{"code": "81417", "type": "CPT"}], "standard_charges": [{"minimum": 320.0, "maximum": 320.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOME SEQUENCE ANALYSIS", "code_information": [{"code": "81415", "type": "CPT"}], "standard_charges": [{"minimum": 4780.0, "maximum": 4780.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4780.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOME SEQUENCE ANALYSIS", "code_information": [{"code": "81416", "type": "CPT"}], "standard_charges": [{"minimum": 12000.0, "maximum": 12000.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG LXTR ART", "code_information": [{"code": "35703", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG NECK ART", "code_information": [{"code": "35701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 562.33, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 562.33, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 562.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 562.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 562.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG UXTR ART", "code_information": [{"code": "35702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION BEHIND ABDOMEN", "code_information": [{"code": "49010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 869.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 869.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 869.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 869.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 869.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION BEHIND UPPER JAW", "code_information": [{"code": "31040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR TESTIS", "code_information": [{"code": "54550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR TESTIS", "code_information": [{"code": "54560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION MAXILLARY SINUS", "code_information": [{"code": "31020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION MAXILLARY SINUS", "code_information": [{"code": "31030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION MAXILLARY SINUS", "code_information": [{"code": "31256", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5235.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ABDOMEN", "code_information": [{"code": "49000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 713.79, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 713.79, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 713.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 713.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 713.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ABDOMEN", "code_information": [{"code": "58960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 902.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 902.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 902.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 902.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 902.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ANKLE JOINT", "code_information": [{"code": "27612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF BILE DUCTS", "code_information": [{"code": "47700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 960.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 960.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 960.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 960.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 960.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "32100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 957.69, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 957.69, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 957.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 957.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 957.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 819.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 819.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 819.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 819.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 819.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FOOT JOINT", "code_information": [{"code": "28020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FOOT JOINT", "code_information": [{"code": "28022", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FRONTAL SINUS", "code_information": [{"code": "31070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FRONTAL SINUS", "code_information": [{"code": "31075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF HIP JOINT", "code_information": [{"code": "27033", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF KIDNEY", "code_information": [{"code": "50010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 717.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 717.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 717.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 717.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 717.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF KNEE JOINT", "code_information": [{"code": "27310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF MIDDLE EAR", "code_information": [{"code": "69440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF SINUSES", "code_information": [{"code": "31090", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF SPINAL FUSION", "code_information": [{"code": "22830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 794.63, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 794.63, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 794.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 794.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 794.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF TOE JOINT", "code_information": [{"code": "28024", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF URETER", "code_information": [{"code": "50600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 965.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 965.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 965.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 965.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 965.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF VAGINA", "code_information": [{"code": "57000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION SPHENOID SINUS", "code_information": [{"code": "31050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1011.1, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1011.1, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1011.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1011.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1011.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1478.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1478.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1478.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1478.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1478.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY HEART SURGERY", "code_information": [{"code": "33310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1180.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1180.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1180.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1180.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1180.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY HEART SURGERY", "code_information": [{"code": "33315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1476.56, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1476.56, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1476.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1476.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1476.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY SHOULDER SURGERY", "code_information": [{"code": "23040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY SHOULDER SURGERY", "code_information": [{"code": "23044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE ABDOMINAL VESSELS", "code_information": [{"code": "35840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 643.74, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 643.74, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 643.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 643.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 643.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1028.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1028.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1028.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1028.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1028.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST FREE ADHESIONS", "code_information": [{"code": "32124", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 906.71, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 906.71, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 906.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 906.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 906.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST VESSELS", "code_information": [{"code": "35820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1778.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1778.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1778.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1778.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1778.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE DEEP NODE(S) NECK", "code_information": [{"code": "38542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE EPIDIDYMIS", "code_information": [{"code": "54865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE INNER EAR", "code_information": [{"code": "69805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE INNER EAR", "code_information": [{"code": "69806", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE LIMB VESSELS", "code_information": [{"code": "35860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 423.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 423.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 423.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 423.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 423.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE NECK VESSELS", "code_information": [{"code": "35800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 499.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 499.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 499.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 499.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 499.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE ORBIT/REMOVE LESION", "code_information": [{"code": "61333", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1768.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1768.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1768.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1768.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1768.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE PARATHYROID GLANDS", "code_information": [{"code": "60500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 958.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 958.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 958.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 958.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 958.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE PARATHYROID GLANDS", "code_information": [{"code": "60505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1329.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1329.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1329.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1329.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1329.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE SCROTUM", "code_information": [{"code": "55110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 21860.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE SINUS REMOVE POLYPS", "code_information": [{"code": "31032", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE SMALL INTESTINE", "code_information": [{"code": "44020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 881.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 881.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 881.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 881.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 881.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE TREAT SHOULDER JOINT", "code_information": [{"code": "23107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND ABDOMEN", "code_information": [{"code": "20102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 481.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 481.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 481.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 481.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 481.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND CHEST", "code_information": [{"code": "20101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 411.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 411.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 411.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 411.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 411.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND EXTREMITY", "code_information": [{"code": "20103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 430.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 430.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 430.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 430.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 430.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND NECK", "code_information": [{"code": "20100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 574.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 574.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 574.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 574.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 574.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/BIOPSY EYE SOCKET", "code_information": [{"code": "67400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/BIOPSY EYE SOCKET", "code_information": [{"code": "67450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/DRAIN EYE SOCKET", "code_information": [{"code": "67405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/DRAIN EYE SOCKET", "code_information": [{"code": "67440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/IRRIGATE TEAR DUCTS", "code_information": [{"code": "68840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/REPAIR CHEST", "code_information": [{"code": "32110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1429.77, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1429.77, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1429.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1429.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1429.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT ANKLE JOINT", "code_information": [{"code": "27610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT ANKLE JOINT", "code_information": [{"code": "27620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67413", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT FINGER JOINT", "code_information": [{"code": "26075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT FINGER JOINT", "code_information": [{"code": "26080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT HAND JOINT", "code_information": [{"code": "26070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT KNEE JOINT", "code_information": [{"code": "27331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT WRIST JOINT", "code_information": [{"code": "25040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT WRIST JOINT", "code_information": [{"code": "25101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLR/DECOMPRESS EYE SOCKET", "code_information": [{"code": "67414", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLR/DECOMPRESS EYE SOCKET", "code_information": [{"code": "67445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPOSURE OF UNERUPTED TOOTH", "code_information": [{"code": "D7280", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT CANNULA DECLOTTING", "code_information": [{"code": "5600979", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1961.0, "discounted_cash": 1470.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D RECORDING", "code_information": [{"code": "93242", "type": "CPT"}], "standard_charges": [{"minimum": 45.81, "maximum": 52.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 47.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 45.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D REV&INTERPJ", "code_information": [{"code": "93244", "type": "CPT"}], "standard_charges": [{"minimum": 45.6, "maximum": 52.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 45.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D SCAN A/R", "code_information": [{"code": "93243", "type": "CPT"}], "standard_charges": [{"minimum": 75.35, "maximum": 86.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 77.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 75.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 86.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 86.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 86.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D RECORDING", "code_information": [{"code": "93246", "type": "CPT"}], "standard_charges": [{"minimum": 75.35, "maximum": 86.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 77.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 75.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 86.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 86.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 86.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D REV&INTERPJ", "code_information": [{"code": "93248", "type": "CPT"}], "standard_charges": [{"minimum": 50.07, "maximum": 57.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 51.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D SCAN A/R", "code_information": [{"code": "93247", "type": "CPT"}], "standard_charges": [{"minimum": 151.55, "maximum": 173.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 156.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 151.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 173.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 173.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 173.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDED CULTURE OF OOCYTES", "code_information": [{"code": "89272", "type": "CPT"}], "standard_charges": [{"minimum": 656.15, "maximum": 656.15, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDED VISUAL FIELD XM", "code_information": [{"code": "92083", "type": "CPT"}], "standard_charges": [{"minimum": 85.33, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 85.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 85.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 85.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 85.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 85.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDER BUTTN TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 338.94, "maximum": 338.94, "gross_charge": 1614.0, "discounted_cash": 1210.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 338.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [{"code": "927", "type": "MS-DRG"}], "standard_charges": [{"minimum": 708879.3, "maximum": 893283.57, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 708879.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 893283.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [{"code": "933", "type": "MS-DRG"}], "standard_charges": [{"minimum": 129295.23, "maximum": 162929.43, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 129295.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 162929.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE EAR CANAL SURGERY", "code_information": [{"code": "69150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE EAR/NECK SURGERY", "code_information": [{"code": "69155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1686.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1686.59, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1686.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1686.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1686.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HAND SURGERY", "code_information": [{"code": "26250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1279.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1279.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1279.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1279.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1279.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1702.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1702.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1702.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1702.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1702.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1288.26, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1288.26, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1288.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1288.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1288.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE JAW SURGERY", "code_information": [{"code": "21045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1197.58, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1197.58, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1197.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1197.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1197.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "982", "type": "MS-DRG"}], "standard_charges": [{"minimum": 81627.12, "maximum": 102861.18, "estimated_discounted_cash": 133579.25, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 81627.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 102861.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [{"code": "981", "type": "MS-DRG"}], "standard_charges": [{"minimum": 155777.14, "maximum": 196300.22, "estimated_discounted_cash": 172747.09, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 155777.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 196300.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "983", "type": "MS-DRG"}], "standard_charges": [{"minimum": 56908.23, "maximum": 71712.05, "estimated_discounted_cash": 112672.26, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 56908.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 71712.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1361.91, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1361.91, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1361.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1361.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1361.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55812", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1654.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1654.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1654.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1654.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1654.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1829.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1829.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1829.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1829.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1829.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1388.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1388.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1388.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1388.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1388.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1696.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1696.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1696.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1696.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1696.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55862", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1150.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1150.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1150.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1150.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1150.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1380.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1380.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1380.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1380.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1380.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE REMOVAL OF LIVER", "code_information": [{"code": "47122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3168.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3168.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3168.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3168.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3168.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1237.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1237.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1237.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1237.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1237.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21632", "type": "CPT"}], "standard_charges": [{"minimum": 1218.57, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1218.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1218.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1218.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1218.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1218.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 961.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 961.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 961.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 961.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 961.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42844", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1364.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1364.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1364.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1364.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1364.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2185.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2185.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2185.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2185.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2185.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE TESTIS SURGERY", "code_information": [{"code": "54535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE THYROID SURGERY", "code_information": [{"code": "60254", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1628.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1628.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1628.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1628.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1628.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 847.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 847.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 847.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 847.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 847.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56631", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1083.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1083.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1083.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1083.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1083.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1242.6, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1242.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1242.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1242.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1242.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1101.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1101.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1101.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1101.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1101.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.8, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.8, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56637", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1386.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1386.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1386.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1386.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1386.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1376.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1376.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1376.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1376.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1376.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTERNAL CANNULA DECLOTTING", "code_information": [{"code": "36860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 110.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 110.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 110.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 110.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 110.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTERNAL OCULAR PHOTOGRAPHY", "code_information": [{"code": "92285", "type": "CPT"}], "standard_charges": [{"minimum": 48.39, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTERNAL RECEIVER, CGM SYS", "code_information": [{"code": "A9278", "type": "HCPCS"}], "standard_charges": [{"minimum": 655.05, "maximum": 749.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 674.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 655.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 749.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 749.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 749.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTERNAL TRANSMITTER, CGM", "code_information": [{"code": "A9277", "type": "HCPCS"}], "standard_charges": [{"minimum": 644.8, "maximum": 737.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 663.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 644.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 737.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 737.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 737.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTERNAL VERSION", "code_information": [{"code": "3120455", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"gross_charge": 4476.0, "discounted_cash": 3357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTERNAL VERSION", "code_information": [{"code": "3120455", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"gross_charge": 4476.0, "discounted_cash": 3357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTND COLOR VISION XM", "code_information": [{"code": "92283", "type": "CPT"}], "standard_charges": [{"minimum": 48.29, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRA AMBULANCE ATTENDANT", "code_information": [{"code": "A0424", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "38", "type": "MS-DRG"}], "standard_charges": [{"minimum": 53873.57, "maximum": 67887.96, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 53873.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 67887.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "37", "type": "MS-DRG"}], "standard_charges": [{"minimum": 109304.3, "maximum": 137738.17, "estimated_discounted_cash": 113188.3, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 109304.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137738.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "39", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39028.95, "maximum": 49181.74, "estimated_discounted_cash": 74448.8, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39028.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49181.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACTION OF LENS", "code_information": [{"code": "66920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACTION OF LENS", "code_information": [{"code": "66930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACTION OF LENS", "code_information": [{"code": "66940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 666.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 666.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 666.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 666.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 666.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [{"code": "115", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5436.18, "maximum": 64218.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8490.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11733.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17755.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32477.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18682.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12345.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8933.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34173.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13036.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19728.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36086.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9433.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36086.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9433.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13036.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19728.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19728.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9433.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36086.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13036.92, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 25148.35, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7604.39, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5436.18, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 12508.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50961.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 64218.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [{"code": "790", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30.0, "maximum": 8963.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7113.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8963.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTRNL COUNTERPULSE, PER TX", "code_information": [{"code": "G0166", "type": "HCPCS"}], "standard_charges": [{"minimum": 3243.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE ALLERGY TESTS", "code_information": [{"code": "95060", "type": "CPT"}], "standard_charges": [{"minimum": 25.45, "maximum": 25.45, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE DETECTION OF FOR/BDY", "code_information": [{"code": "70030", "type": "CPT"}, {"code": "4900030", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 144.06, "gross_charge": 686.0, "discounted_cash": 514.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 144.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.95, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE DETECTION OF FOR/BDY", "code_information": [{"code": "70030", "type": "CPT"}, {"code": "5010030", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 109.41, "gross_charge": 521.0, "discounted_cash": 390.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 109.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE IOL ASPHERIC", "code_information": [{"code": "C1780", "type": "HCPCS"}, {"code": "8122039", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 160.44, "maximum": 160.44, "gross_charge": 764.0, "discounted_cash": 573.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 160.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE PHOTODYNAMIC THER ADD-ON", "code_information": [{"code": "67225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EYE SURGERY FOLLOW-UP ADD-ON", "code_information": [{"code": "67331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EYE SUTURE DURING SURGERY", "code_information": [{"code": "67335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EZDERM", "code_information": [{"code": "Q4136", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EZETIMIBE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304875", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "billing_class": "facility"}]}, {"description": "EZETIMIBE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304875", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "billing_class": "facility"}]}, {"description": "EZH2 GENE COMMON VARIANTS", "code_information": [{"code": "81237", "type": "CPT"}], "standard_charges": [{"minimum": 175.4, "maximum": 175.4, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EZH2 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81236", "type": "CPT"}], "standard_charges": [{"minimum": 282.88, "maximum": 282.88, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ecg not performed", "code_information": [{"code": "G8707", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ecg performed", "code_information": [{"code": "G8704", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Eld maltreatment doc as pos", "code_information": [{"code": "G8941", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Electrophysiologic evaluation of cardiac contractility modulation-defibrillator leads, including defibrillation-threshold evaluation (induction of arrhythmia, evaluation of sensing and therapy for arrhythmia termination), at time of initial implantation o", "code_information": [{"code": "930T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Electrophysiologic evaluation of cardiac contractility modulation-defibrillator leads, including defibrillation-threshold evaluation (induction of arrhythmia, evaluation of sensing and therapy for arrhythmia termination), separate from initial implantatio", "code_information": [{"code": "931T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4898.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Endoscopic defect closure within the entire gastrointestinal tract, including upper endoscopy (including diagnostic, if performed) or colonoscopy (including diagnostic, if performed), with all system and tissue anchoring components", "code_information": [{"code": "C9901", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ensifentrine, inhalation suspension, FDA approved final product, non-compounded, administered through DME, unit dose form, 3 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7601", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.91, "maximum": 52.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 52.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Epifix or epicord", "code_information": [{"code": "Q4131", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Eps stomach plic", "code_information": [{"code": "C9724", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Esophagoscopy, flexible, transoral, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for esophageal stricture, including fluoroscopic guidance, when perform", "code_information": [{"code": "884T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Established Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 1 Hour", "code_information": [{"code": "99337", "type": "CPT"}], "standard_charges": [{"minimum": 176.3, "maximum": 176.3, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 176.3, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 176.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 176.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 176.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 176.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Established Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 15 Minutes", "code_information": [{"code": "99334", "type": "CPT"}], "standard_charges": [{"minimum": 57.06, "maximum": 57.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Established Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 25 Minutes", "code_information": [{"code": "99335", "type": "CPT"}], "standard_charges": [{"minimum": 87.22, "maximum": 87.22, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 87.22, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 87.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 87.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 87.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 87.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Established Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 40 Minutes", "code_information": [{"code": "99336", "type": "CPT"}], "standard_charges": [{"minimum": 123.05, "maximum": 123.05, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.05, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Examination Of Bladder And Urethra With Mechanical Dilation And Drug Delivery For Narrowing Of Urethra Using An Endoscope", "code_information": [{"code": "499T", "type": "CPT"}], "standard_charges": [{"minimum": 12252.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 10.1 to 20 cm", "code_information": [{"code": "49188", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 20.1 to 30 cm", "code_information": [{"code": "49189", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 5 cm or less", "code_information": [{"code": "49186", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 5.1 to 10 cm", "code_information": [{"code": "49187", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); greater than 30 cm", "code_information": [{"code": "49190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extra-Corporeal Shock Wave Therapy, General", "code_information": [{"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F EMB TRNS CANC CASE RATE", "code_information": [{"code": "S4018", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "F2 GENE ANLS VARIANT/2", "code_information": [{"code": "81240", "type": "CPT"}, {"code": "7259208", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 251.3, "gross_charge": 637.0, "discounted_cash": 477.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 251.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 65.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 65.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F5 LEIDEN VARIANT", "code_information": [{"code": "81241", "type": "CPT"}, {"code": "7259207", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 312.08, "gross_charge": 408.0, "discounted_cash": 306.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 312.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 73.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 73.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F9 FULL GENE SEQUENCE", "code_information": [{"code": "81238", "type": "CPT"}], "standard_charges": [{"minimum": 600.0, "maximum": 600.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACE BONE GRAFT", "code_information": [{"code": "21210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACIAL BONES 2VW MAX", "code_information": [{"code": "70140", "type": "CPT"}, {"code": "4900140", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 165.06, "gross_charge": 786.0, "discounted_cash": 589.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 165.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 77.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL BONES 2VW MAX", "code_information": [{"code": "70140", "type": "CPT"}, {"code": "5010140", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 165.06, "gross_charge": 786.0, "discounted_cash": 589.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 165.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 77.79, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL BONES 3VW MIN", "code_information": [{"code": "70150", "type": "CPT"}, {"code": "4900150", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 271.74, "gross_charge": 1294.0, "discounted_cash": 970.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 271.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 102.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL BONES 3VW MIN", "code_information": [{"code": "70150", "type": "CPT"}, {"code": "5010150", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 271.74, "gross_charge": 1294.0, "discounted_cash": 970.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 271.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 102.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL NERVE FUNCTION TEST", "code_information": [{"code": "92516", "type": "CPT"}], "standard_charges": [{"minimum": 55.72, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 55.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 55.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 55.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 55.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 55.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACILITY SVS DENTAL REHAB", "code_information": [{"code": "G0330", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACTOR INHIBITOR", "code_information": [{"code": "85335", "type": "CPT"}, {"code": "7251292", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.66, "gross_charge": 254.0, "discounted_cash": 190.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.66, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX ALPROLIX RECOMB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7201", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.23, "maximum": 3.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX COMPLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7194", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.53, "maximum": 1.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX IDELVION INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7202", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.79, "maximum": 5.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX NON-RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7193", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.26, "maximum": 1.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX RECOMB GLY REBINYN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7203", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.01, "maximum": 4.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX RECOMBINANT NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7195", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.67, "maximum": 1.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIIA RECOMB NOVOSEVEN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7189", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.39, "maximum": 2.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7190", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.98, "maximum": 1.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII (PORCINE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7191", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.67, "maximum": 1.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII FC FUSION RECOMB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7205", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.19, "maximum": 2.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII NUWIQ RECOMB 1IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7209", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.01, "maximum": 1.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.12, "methodology": "fee schedule"}, 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAT OR LIPID FECES QUANT", "code_information": [{"code": "82710", "type": "CPT"}, {"code": "7252710", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.67, "gross_charge": 354.0, "discounted_cash": 265.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 85.67, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAT STAIN FECES/URIN/ETC", "code_information": [{"code": "89125", "type": "CPT"}, {"code": "7258912", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 22.01, "gross_charge": 238.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 22.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FCSD US ABLTJ LEIOMYOM>=200", "code_information": [{"code": "72T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS 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{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FDP FSP AGGLUTNATN SEMQTY", "code_information": [{"code": "85362", "type": "CPT"}, {"code": "4105362", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.11, "gross_charge": 172.0, "discounted_cash": 129.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 35.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FDP FSP AGGLUTNATN SEMQTY", "code_information": [{"code": "85362", "type": "CPT"}, {"code": "7255362", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.11, "gross_charge": 172.0, "discounted_cash": 129.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 35.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FE PYRO CIT POW 0.1 MG IRON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1444", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.04, 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"standard_charge_dollar": 6.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL BLOOD SCRN IMMUNOASSAY", "code_information": [{"code": "G0328", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 81.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 81.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL ELASTASE EL1 QN", "code_information": [{"code": "82653", "type": "CPT"}, {"code": "7252654", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 22.97, "maximum": 22.97, "gross_charge": 533.0, "discounted_cash": 399.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL ELASTASE EL1 QN/2", "code_information": [{"code": "82653", "type": "CPT"}, {"code": "7258270", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 22.97, "maximum": 22.97, "gross_charge": 303.0, "discounted_cash": 227.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL ELASTASE EL1 QN/4", "code_information": [{"code": "82653", "type": "CPT"}, {"code": "7258355", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 22.97, "maximum": 22.97, "gross_charge": 144.0, "discounted_cash": 108.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL MICROBIOTA INSTILL", "code_information": [{"code": "5070050", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"gross_charge": 667.0, "discounted_cash": 500.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FECAL MICROBIOTA JSLM 1 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1440", "type": "HCPCS"}], "standard_charges": [{"minimum": 57.46, "maximum": 63.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 57.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 63.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 63.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 63.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 63.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL MICROBIOTA PREP INSTIL", "code_information": [{"code": "G0455", "type": "HCPCS"}], "standard_charges": [{"minimum": 4200.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEES W/LARYNGEAL SENSE I&R", "code_information": [{"code": "92617", "type": "CPT"}], "standard_charges": [{"minimum": 44.58, "maximum": 44.58, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 44.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 44.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEES W/LARYNGEAL SENSE TEST", "code_information": [{"code": "92616", "type": "CPT"}], "standard_charges": [{"minimum": 198.52, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 216.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 204.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 198.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 227.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 227.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 227.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 216.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 216.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 216.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 216.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FELBAMATE", "code_information": [{"code": "80167", "type": "CPT"}, {"code": "7250088", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.64, "maximum": 18.64, "gross_charge": 129.0, "discounted_cash": 96.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM AUGMENT COMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8132503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1437.03, "maximum": 1437.03, "gross_charge": 6843.0, "discounted_cash": 5132.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1437.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM CEMENT REST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8174600", "type": "CDM"}], "standard_charges": [{"minimum": 2621.01, "maximum": 2621.01, "gross_charge": 12481.0, "discounted_cash": 9360.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2621.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM COMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8132505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 932.4, "maximum": 932.4, "gross_charge": 4440.0, "discounted_cash": 3330.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 932.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM COMPONENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8132500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9198.84, "maximum": 9198.84, "gross_charge": 43804.0, "discounted_cash": 32853.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 9198.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM NAIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3058.86, "maximum": 3058.86, "gross_charge": 14566.0, "discounted_cash": 10924.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3058.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8132535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5913.6, "maximum": 5913.6, "gross_charge": 28160.0, "discounted_cash": 21120.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 5913.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POP REVASC W/ARTHR & US", "code_information": [{"code": "C7534", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POP REVASC W/STENT & US", "code_information": [{"code": "C7535", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/ATHER", "code_information": [{"code": "37225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/TLA", "code_information": [{"code": "37224", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC STNT & ATHER", "code_information": [{"code": "37227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC W/STENT", "code_information": [{"code": "37226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [{"code": "748", "type": "MS-DRG"}], "standard_charges": [{"minimum": 46061.13, "maximum": 58043.24, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46061.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 58043.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEMORAL ENDOVAS GRAFT ADD-ON", "code_information": [{"code": "34813", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 246.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 246.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 246.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 246.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 246.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEMUR 1 VW", "code_information": [{"code": "73551", "type": "CPT"}, {"code": "4903552", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 128.94, "gross_charge": 614.0, "discounted_cash": 460.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 128.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 101.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR 1 VW", "code_information": [{"code": "73551", "type": "CPT"}, {"code": "5013552", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 128.94, "gross_charge": 614.0, "discounted_cash": 460.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 128.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 101.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR 2 VIEWS MIN", "code_information": [{"code": "73552", "type": "CPT"}, {"code": "4903551", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 117.9, "gross_charge": 1183.0, "discounted_cash": 887.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 117.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR 2 VIEWS MIN", "code_information": [{"code": "73552", "type": "CPT"}, {"code": "5013550", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 117.9, "gross_charge": 1183.0, "discounted_cash": 887.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 117.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FENOFIBRATE 145MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304938", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 18.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FENOFIBRATE 145MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304938", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 18.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FENOFIBRATE 48MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304933", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FENOFIBRATE 48MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304933", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FENTANYL", "code_information": [{"code": "80354", "type": "CPT"}, {"code": "7253936", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 779.0, "discounted_cash": 584.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FERN TEST", "code_information": [{"code": "Q0114", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.74, "maximum": 9.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FERRITIN", "code_information": [{"code": "82728", "type": "CPT"}, {"code": "4102726", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.46, "gross_charge": 400.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.46, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FERUMOXYTOL, ESRD USE", "code_information": [{"code": "Q0139", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.29, "maximum": 0.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FERUMOXYTOL, NON-ESRD", "code_information": [{"code": "Q0138", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.29, "maximum": 0.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL ANEUPLOIDY TRISOM RISK", "code_information": [{"code": "81507", "type": "CPT"}], "standard_charges": [{"minimum": 795.0, "maximum": 795.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 795.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 795.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFLE NST", "code_information": [{"code": "76818", "type": "CPT"}, {"code": "3100175", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 435.75, "gross_charge": 2075.0, "discounted_cash": 1556.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 435.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 222.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFLE NST", "code_information": [{"code": "76818", "type": "CPT"}, {"code": "5066818", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 435.75, "gross_charge": 2075.0, "discounted_cash": 1556.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 435.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFLE NST", "code_information": [{"code": "76818", "type": "CPT"}, {"code": "6166818", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 435.75, "gross_charge": 2075.0, "discounted_cash": 1556.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 435.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 222.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 137.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS W/O STRESS", "code_information": [{"code": "76819", "type": "CPT"}, {"code": "5066180", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 219.45, "gross_charge": 1045.0, "discounted_cash": 783.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 219.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 206.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML ANEUPLOIDY", "code_information": [{"code": "81420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2987.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2987.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 759.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 759.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML MICRODELTJ", "code_information": [{"code": "81422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2987.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2987.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 759.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 759.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CONTRACT STRESS TEST", "code_information": [{"code": "59020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL CORD PUNCTURE PRENATAL", "code_information": [{"code": "59012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL CV ECHO W/DOPP F/U", "code_information": [{"code": "76828", "type": "CPT"}, {"code": "5066879", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 304.08, "gross_charge": 1448.0, "discounted_cash": 1086.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 304.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 129.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 67.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 67.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 67.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 67.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 67.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CV ECHO W/DOPPLER", "code_information": [{"code": "76827", "type": "CPT"}, {"code": "5066877", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 459.69, "gross_charge": 2189.0, "discounted_cash": 1641.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 459.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 204.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 93.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 93.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 93.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 93.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 93.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL FIBRONECTIN", "code_information": [{"code": "82731", "type": "CPT"}, {"code": "4102731", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 328.46, "gross_charge": 1260.0, "discounted_cash": 945.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 328.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.99, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL FLUID DRAINAGE W/US", "code_information": [{"code": "59074", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 375.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 375.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 375.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 375.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 375.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR W/REPORT", "code_information": [{"code": "59050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 50.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 50.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 50.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 50.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 50.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR/INTERPRET ONLY", "code_information": [{"code": "59051", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL NON-STRESS TEST", "code_information": [{"code": "59025", "type": "CPT"}, {"code": "3100176", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 1498.0, "discounted_cash": 1123.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 314.58, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 1423.1, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 232.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 225.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 258.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 258.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 258.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 1423.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 552.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 1123.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 1123.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL NON-STRESS TEST", "code_information": [{"code": "59025", "type": "CPT"}, {"code": "6169025", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 1498.0, "discounted_cash": 1123.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 314.58, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 1423.1, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 232.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 225.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 258.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 258.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 258.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 1423.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 552.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 1123.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 1123.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL RBC ROSETTE", "code_information": [{"code": "85461", "type": "CPT"}, {"code": "4102720", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.8, "gross_charge": 356.0, "discounted_cash": 267.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SCALP BLOOD SAMPLE", "code_information": [{"code": "59030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 110.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 110.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 110.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 110.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 110.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL SHUNT PLACEMENT W/US", "code_information": [{"code": "59076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL SURG CONG CYST MALF", "code_information": [{"code": "S2402", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SURG CONGEN HERNIA", "code_information": [{"code": "S2400", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SURG MYELOMENINGO", "code_information": [{"code": "S2404", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SURG NOC", "code_information": [{"code": "S2409", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SURG PULMON SEQUEST", "code_information": [{"code": "S2403", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SURG SACROCOC TERATOMA", "code_information": [{"code": "S2405", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SURG URIN TRAC OBSTR", "code_information": [{"code": "S2401", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETOSCOP LASER THER TTTS", "code_information": [{"code": "S2411", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [{"code": "864", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29473.42, "maximum": 37140.48, "estimated_discounted_cash": 97507.33, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29473.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37140.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FFP THAW EA UNIT", "code_information": [{"code": "86927", "type": "CPT"}, {"code": "4106264", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "gross_charge": 254.0, "discounted_cash": 190.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIASP FOR INSULIN PUMP USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1811", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.43, "maximum": 8.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADJ D-DIMER", "code_information": [{"code": "85380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.22, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN ACTIVITY", "code_information": [{"code": "85384", "type": "CPT"}, {"code": "4105384", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.33, "gross_charge": 282.0, "discounted_cash": 211.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 43.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN ANTIGEN", "code_information": [{"code": "85385", "type": "CPT"}, {"code": "7252730", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.33, "gross_charge": 187.0, "discounted_cash": 140.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 43.33, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN TEST", "code_information": [{"code": "85366", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 80.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 43.91, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN TEST", "code_information": [{"code": "85370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 57.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYSINS SCREEN I&R", "code_information": [{"code": "85390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMIN", "code_information": [{"code": "85400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.11, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 45.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMINOGEN", "code_information": [{"code": "85421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRNOLTIC PLSMNOGEN ACT", "code_information": [{"code": "85415", "type": "CPT"}, {"code": "7255415", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 87.67, "gross_charge": 446.0, "discounted_cash": 334.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 87.67, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRNOLTIC PLSMNOGEN XCPT AG", "code_information": [{"code": "85420", "type": "CPT"}, {"code": "7255420", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.32, "gross_charge": 339.0, "discounted_cash": 254.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.32, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.13, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBULA BONE GRAFT MICROVASC", "code_information": [{"code": "20955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2499.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2499.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2499.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2499.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2499.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIDAXOMICIN 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305069", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1226.0, "discounted_cash": 919.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FIDAXOMICIN 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305069", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1226.0, "discounted_cash": 919.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLER BN VOID CHRONOS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132584", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2099.37, "maximum": 2099.37, "gross_charge": 9997.0, "discounted_cash": 7497.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2099.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FILLETED FINGER/TOE FLAP", "code_information": [{"code": "14350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FILTER VENA CAVA", "code_information": [{"code": "C1880", "type": "HCPCS"}, {"code": "8240143", "type": "CDM"}], "standard_charges": [{"minimum": 1581.72, "maximum": 1581.72, "gross_charge": 7532.0, "discounted_cash": 5649.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1581.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FILTERED SPEECH HEARING TEST", "code_information": [{"code": "92571", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIMBRIOPLASTY", "code_information": [{"code": "58760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 809.91, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 809.91, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 809.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 809.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 809.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FINASTERIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305066", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FINASTERIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305066", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FINASTERIDE, 5 MG", "code_information": [{"code": "S0138", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.15, "maximum": 0.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINGER TENDON TRANSFER", "code_information": [{"code": "26497", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FINGER TENDON TRANSFER", "code_information": [{"code": "26498", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FINGER(S) 2 VIEWS", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "4903140", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 315.21, "gross_charge": 1501.0, "discounted_cash": 1125.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 315.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINGER(S) 2 VIEWS", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "5013140", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 315.21, "gross_charge": 1501.0, "discounted_cash": 1125.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 315.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULA REPAIR & COLOSTOMY", "code_information": [{"code": "57307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 961.56, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 961.56, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 961.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 961.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 961.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FISTULA REPAIR TRANSPERINE", "code_information": [{"code": "57308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 623.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 623.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 623.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 623.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 623.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FISTULA-SINUS TRCT STDY", "code_information": [{"code": "76080", "type": "CPT"}, {"code": "4906082", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 482.89, "gross_charge": 1441.0, "discounted_cash": 1080.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 302.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULA-SINUS TRCT STDY", "code_information": [{"code": "76080", "type": "CPT"}, {"code": "4916082", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 482.89, "gross_charge": 1441.0, "discounted_cash": 1080.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 302.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULA-SINUS TRCT STDY", "code_information": [{"code": "76080", "type": "CPT"}, {"code": "5016082", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 482.89, "gross_charge": 1441.0, "discounted_cash": 1080.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 302.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT APHAKIA SPECTCL MONOFOCL", "code_information": [{"code": "92352", "type": "CPT"}], "standard_charges": [{"minimum": 41.47, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT APHAKIA SPECTCL MULTIFOC", "code_information": [{"code": "92353", "type": "CPT"}], "standard_charges": [{"minimum": 48.05, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES BIFOCAL", "code_information": [{"code": "92341", "type": "CPT"}], "standard_charges": [{"minimum": 47.32, "maximum": 54.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 48.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 47.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 54.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 54.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 54.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES MONOFOCAL", "code_information": [{"code": "92340", "type": "CPT"}], "standard_charges": [{"minimum": 36.87, "maximum": 42.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 42.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 42.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 42.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES MULTIFOCAL", "code_information": [{"code": "92342", "type": "CPT"}], "standard_charges": [{"minimum": 53.63, "maximum": 61.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 55.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 53.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 61.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 61.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 61.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITG SPECT LOW VIS 1SYSTEM", "code_information": [{"code": "92354", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 213.81, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 213.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 213.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 213.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 213.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 213.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITG SPECT LW VIS CMPND LENS", "code_information": [{"code": "92355", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 110.31, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 110.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 110.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 110.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 110.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 110.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITTING OF DIAPHRAGM/CAP", "code_information": [{"code": "57170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FITZGERALD FACTOR ASSAY", "code_information": [{"code": "85293", "type": "CPT"}, {"code": "7255293", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 96.58, "gross_charge": 417.0, "discounted_cash": 312.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 96.58, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIX G/COLON TUBE W/DEVICE", "code_information": [{"code": "49460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXATION OF ANKLE JOINT", "code_information": [{"code": "27860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXATION OF KNEE JOINT", "code_information": [{"code": "27570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6723.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXATION OF SHOULDER BLADE", "code_information": [{"code": "23400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLEBOGAMMA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1572", "type": "HCPCS"}], "standard_charges": [{"minimum": 54.32, "maximum": 60.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 54.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLECAINIDE", "code_information": [{"code": "80181", "type": "CPT"}, {"code": "7250089", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.64, "maximum": 18.64, "gross_charge": 129.0, "discounted_cash": 96.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLECAINIDE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305085", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLECAINIDE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305085", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLECAINIDE/2", "code_information": [{"code": "80181", "type": "CPT"}, {"code": "7250300", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.64, "maximum": 18.64, "gross_charge": 107.0, "discounted_cash": 80.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLETCHER FACTOR ASSAY", "code_information": [{"code": "85292", "type": "CPT"}, {"code": "7258530", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 96.58, "gross_charge": 488.0, "discounted_cash": 366.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 96.58, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEX GRAFTON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8141598", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1222.41, "maximum": 1222.41, "gross_charge": 5821.0, "discounted_cash": 4365.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1222.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXHD PLIABLE PERF PER SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "4021061", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 31.92, "maximum": 31.92, "gross_charge": 152.0, "discounted_cash": 114.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 31.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXHD PLIABLE PERF PER SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "4021061", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 31.92, "maximum": 31.92, "gross_charge": 152.0, "discounted_cash": 114.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 31.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXOR-PLASTY ELBOW", "code_information": [{"code": "24330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLEXOR-PLASTY ELBW W/ADVMNT", "code_information": [{"code": "24331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLORBETABEN F18 DIAGNOSTIC", "code_information": [{"code": "Q9983", "type": "HCPCS"}], "standard_charges": [{"minimum": 3488.4, "maximum": 3876.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3488.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3876.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3876.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3876.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3876.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLORBETAPIR F18", "code_information": [{"code": "A9586", "type": "HCPCS"}], "standard_charges": [{"minimum": 2931.7, "maximum": 3257.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2931.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3257.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3257.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3257.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3257.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLORTAUCIPIR INJ 1 MILLICURI", "code_information": [{"code": "A9601", "type": "HCPCS"}], "standard_charges": [{"minimum": 4407.32, "maximum": 4895.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4407.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4895.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4895.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4895.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4895.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOTUFOLASTAT F18 DIAG 1 MCI", "code_information": [{"code": "A9608", "type": "HCPCS"}], "standard_charges": [{"minimum": 920.64, "maximum": 1022.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 920.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1022.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1022.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1022.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1022.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOW CYTO ADD MARKER", "code_information": [{"code": "88185", "type": "CPT"}, {"code": "7258185", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 120.34, "gross_charge": 249.0, "discounted_cash": 186.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 120.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOW CYTO ADD MARKER/2", "code_information": [{"code": "88185", "type": "CPT"}, {"code": "7010076", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 120.34, "gross_charge": 489.0, "discounted_cash": 366.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 120.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOW CYTO CEL FIRST MRKR", "code_information": [{"code": "88184", "type": "CPT"}, {"code": "7250009", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 291.26, "gross_charge": 489.0, "discounted_cash": 366.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 224.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOW CYTO CEL FIRST MRKR/2", "code_information": [{"code": "88184", "type": "CPT"}, {"code": "7010009", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 291.26, "gross_charge": 4829.0, "discounted_cash": 3621.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 224.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOW CYTO CELL CYCLE/DNA", "code_information": [{"code": "88182", "type": "CPT"}, {"code": "7258182", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 239.29, "gross_charge": 343.0, "discounted_cash": 257.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 239.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOW CYTO INTERP 16+ MARK/4", "code_information": [{"code": "88189", "type": "CPT"}, {"code": "7258191", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 373.47, "gross_charge": 271.0, "discounted_cash": 203.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 373.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 85.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 85.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOW VOLUME LOOPS", "code_information": [{"code": "94375", "type": "CPT"}, {"code": "5500825", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 41.86, "maximum": 392.98, "gross_charge": 888.0, "discounted_cash": 666.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 2-8", "code_information": [{"code": "88187", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 231.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 231.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 36.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 9-15", "code_information": [{"code": "88188", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 286.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 286.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 62.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 62.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOXURIDINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9200", "type": "HCPCS"}], "standard_charges": [{"minimum": 3715.22, "maximum": 4128.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3715.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4128.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4128.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4128.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4128.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE", "code_information": [{"code": "81245", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 621.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 621.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 165.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 165.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE ANALYSIS", "code_information": [{"code": "81246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 311.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 83.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 83.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE ITD VARIANTS QUAN", "code_information": [{"code": "46U", "type": "CPT"}], "standard_charges": [{"minimum": 407.43, "maximum": 407.43, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 407.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 407.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLTR VC OPTEASE", "code_information": [{"code": "C1880", "type": "HCPCS"}, {"code": "8240145", "type": "CDM"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1092.0, "gross_charge": 5200.0, "discounted_cash": 3900.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU IMM NO ADMIN DOC REA", "code_information": [{"code": "G8483", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLU IMMUNIZE NO ADMIN", "code_information": [{"code": "G8484", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLU IMMUNIZE ORDER/ADMIN", "code_information": [{"code": "G8482", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLU VAC > 3 YRS IM PF IJ", "code_information": [{"code": "90656", "type": "CPT"}, {"code": "5320686", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 20.9, "maximum": 23.22, "gross_charge": 83.0, "discounted_cash": 62.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU VAC >3Y 4 VAL PF IJ", "code_information": [{"code": "90686", "type": "CPT"}, {"code": "5320777", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 21.18, "maximum": 23.53, "gross_charge": 137.0, "discounted_cash": 102.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU VAC CCIIV3 >6M 0.5ML IJ", "code_information": [{"code": "90661", "type": "CPT"}, {"code": "5320583", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 44.55, "maximum": 49.5, "gross_charge": 135.0, "discounted_cash": 101.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 44.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU VAC CELL CULT PF IJ", "code_information": [{"code": "90674", "type": "CPT"}, {"code": "5320729", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 32.37, "maximum": 35.97, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 35.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 35.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 35.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 35.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUCICLOVINE F-18", "code_information": [{"code": "A9588", "type": "HCPCS"}], "standard_charges": [{"minimum": 530.08, "maximum": 588.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 530.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 588.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 588.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 588.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 588.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUCONAZ 10MG/ML 5MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315220", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUCONAZ 10MG/ML 5MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315220", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUCONAZOLE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305096", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUCONAZOLE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305096", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUCONAZOLE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305098", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 4.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUCONAZOLE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305098", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 4.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUCONAZOLE10MG/ML35PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315224", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUCONAZOLE10MG/ML35PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315224", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUDARABINE PHOSPHATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9185", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.38, "maximum": 68.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 61.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 68.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 68.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 68.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 68.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUDROCORTISONE .1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305129", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUDROCORTISONE .1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305129", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUID PRESSURE MUSCLE", "code_information": [{"code": "20950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLULAVAL VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2036", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.72, "maximum": 8.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUNISOLIDE 25MCG25ML SP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5330947", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 304.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUNISOLIDE 25MCG25ML SP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5330947", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 304.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUNISOLIDE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7641", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.19, "maximum": 0.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUO BILE DUCT IMAGING W/ICG", "code_information": [{"code": "C9776", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "estimated_discounted_cash": 23756.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN ANGIOSCOPY I&R", "code_information": [{"code": "92230", "type": "CPT"}], "standard_charges": [{"minimum": 71.72, "maximum": 71.72, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 71.72, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 71.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 71.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 71.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 71.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN ANGRPH MLTIFRAME", "code_information": [{"code": "92235", "type": "CPT"}], "standard_charges": [{"minimum": 142.36, "maximum": 392.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 142.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 142.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 142.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 142.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 142.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN&ICG ANGIOGRAPHY", "code_information": [{"code": "92242", "type": "CPT"}], "standard_charges": [{"minimum": 343.64, "maximum": 392.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENCE LYMPH MAP W/ICG", "code_information": [{"code": "C9756", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUORESCENT AB TITER EA", "code_information": [{"code": "86256", "type": "CPT"}, {"code": "7253026", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.47, "gross_charge": 275.0, "discounted_cash": 206.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENT AB TITER EA/11", "code_information": [{"code": "86256", "type": "CPT"}, {"code": "7256256", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.47, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCNT SCRN EA AB", "code_information": [{"code": "86255", "type": "CPT"}, {"code": "7258627", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.47, "gross_charge": 75.0, "discounted_cash": 56.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCNT SCRN EA AB/2", "code_information": [{"code": "86255", "type": "CPT"}, {"code": "7256254", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.47, "gross_charge": 295.0, "discounted_cash": 221.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORIDE", "code_information": [{"code": "82735", "type": "CPT"}, {"code": "7252735", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.57, "gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 94.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORINE-18 FLUORODEOXYGLUCO", "code_information": [{"code": "S8085", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORO BX/ASP/INJ/GUIDE", "code_information": [{"code": "77002", "type": "CPT"}, {"code": "4906010", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 327.39, "gross_charge": 1559.0, "discounted_cash": 1169.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 327.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 164.34, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 83.27, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 83.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 83.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 83.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 83.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORO BX/ASP/INJ/GUIDE", "code_information": [{"code": "77002", "type": "CPT"}, {"code": "4916010", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 327.39, "gross_charge": 1559.0, "discounted_cash": 1169.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 327.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 164.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 83.27, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 83.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 83.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 83.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 83.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORO EXAM OF G/COLON TUBE", "code_information": [{"code": "49465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUORO GUIDE SPINE INJ", "code_information": [{"code": "77003", "type": "CPT"}, {"code": "4906011", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 243.6, "gross_charge": 1160.0, "discounted_cash": 870.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 150.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 74.57, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 74.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 74.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 74.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 74.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORO GUIDE SPINE INJ", "code_information": [{"code": "77003", "type": "CPT"}, {"code": "4916011", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 243.6, "gross_charge": 1160.0, "discounted_cash": 870.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 150.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 74.57, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 74.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 74.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 74.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 74.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORO POLARIZE FETAL LUNG", "code_information": [{"code": "83663", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 96.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 96.47, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORODOPA F-18 DIAG PER MCI", "code_information": [{"code": "A9602", "type": "HCPCS"}], "standard_charges": [{"minimum": 769.46, "maximum": 854.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 769.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 854.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 854.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 854.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 854.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOROESTRADIOL F 18", "code_information": [{"code": "A9591", "type": "HCPCS"}], "standard_charges": [{"minimum": 938.31, "maximum": 1042.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 938.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1042.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1042.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1042.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1042.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOROGUID FOR VEIN DVCE", "code_information": [{"code": "77001", "type": "CPT"}, {"code": "4905997", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 334.32, "gross_charge": 1592.0, "discounted_cash": 1194.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 334.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 213.26, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 112.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 112.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 112.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 112.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 112.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOROGUID FOR VEIN DVCE", "code_information": [{"code": "77001", "type": "CPT"}, {"code": "4915997", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 334.32, "gross_charge": 1592.0, "discounted_cash": 1194.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 334.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 213.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 112.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 112.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 112.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 112.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 112.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOROSCOPY <1HOUR", "code_information": [{"code": "76000", "type": "CPT"}, {"code": "4615998", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 230.13, "gross_charge": 555.0, "discounted_cash": 416.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 116.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 213.26, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOROSCOPY <1HOUR", "code_information": [{"code": "76000", "type": "CPT"}, {"code": "4905998", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 280.35, "gross_charge": 1335.0, "discounted_cash": 1001.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 280.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 213.26, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOROSCOPY <1HOUR", "code_information": [{"code": "76000", "type": "CPT"}, {"code": "4916008", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 280.35, "gross_charge": 1335.0, "discounted_cash": 1001.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 280.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 213.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 103.02, "methodology": "fee schedule"}, 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"PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 70.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 70.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMR1 ABNL ALLELES", "code_information": [{"code": "81243", "type": "CPT"}, {"code": "7010088", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 57.04, "maximum": 57.04, "gross_charge": 444.0, "discounted_cash": 333.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 57.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 57.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMR1 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81244", "type": "CPT"}], "standard_charges": [{"minimum": 44.89, "maximum": 44.89, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY PHYS/PSYCH", "code_information": [{"code": "70555", "type": "CPT"}], "standard_charges": [{"minimum": 230.13, "maximum": 396.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 356.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 396.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 396.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 396.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 396.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY TECH", "code_information": [{"code": "70554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1719.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1719.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 809.37, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 809.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 809.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 809.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 809.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX CT GUIDANCE 1ST LES", "code_information": [{"code": "5050114", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2798.0, "discounted_cash": 2098.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FNA BX CT GUIDANCE EA ADL LES", "code_information": [{"code": "5050115", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3618.0, "discounted_cash": 2713.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FNA BX FLUOR GUIDANCE 1ST LES", "code_information": [{"code": "4910112", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2798.0, "discounted_cash": 2098.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FNA BX US GUIDANCE 1ST LESION", "code_information": [{"code": "4910110", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2908.0, "discounted_cash": 2181.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FNA BX US GUIDANCE 1ST LESION", "code_information": [{"code": "5060110", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2908.0, "discounted_cash": 2181.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FNA BX US GUIDANCE EA ADD LES", "code_information": [{"code": "5060111", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2908.0, "discounted_cash": 2181.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN 1ST LES", "code_information": [{"code": "10009", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN EA ADDL", "code_information": [{"code": "10010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN 1ST LES", "code_information": [{"code": "10007", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN EA ADDL", "code_information": [{"code": "10008", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN 1ST LES", "code_information": [{"code": "10011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN EA ADDL", "code_information": [{"code": "10012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/O IMG GDN 1ST LES", "code_information": [{"code": "10021", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/O IMG GDN EA ADDL", "code_information": [{"code": "10004", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN 1ST LES", "code_information": [{"code": "10005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2598.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN EA ADDL", "code_information": [{"code": "10006", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOA DOC, CARE PLAN NOT DOC", "code_information": [{"code": "G9227", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOA NOT DOC AS BEING PERF", "code_information": [{"code": "G8540", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOAM STABILITY FETAL LUNG", "code_information": [{"code": "83662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 96.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 96.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLIC ACID", "code_information": [{"code": "82746", "type": "CPT"}, {"code": "4102746", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.97, "gross_charge": 399.0, "discounted_cash": 299.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLIC ACID 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305233", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLIC ACID 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305233", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLIC ACID PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1808", "type": "HCPCS"}, {"code": "5320818", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.06, "gross_charge": 0.22, "discounted_cash": 0.17, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLIC ACID PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1808", "type": "HCPCS"}, {"code": "5320818", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.06, "gross_charge": 0.22, "discounted_cash": 0.17, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLIC ACID RBC", "code_information": [{"code": "82747", "type": "CPT"}, {"code": "7252747", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 88.33, "gross_charge": 238.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 88.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLLICLE STIMLAT HORMONE", "code_information": [{"code": "83001", "type": "CPT"}, {"code": "4103001", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.79, "gross_charge": 489.0, "discounted_cash": 366.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 94.79, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.97, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": 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{"description": "FOLLOW UP PULM NOD", "code_information": [{"code": "G9345", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOLLOW-UP SURGERY OF EYE", "code_information": [{"code": "66250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOLLOW-UP/REASSESSMENT", "code_information": [{"code": "S0316", "type": 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"FOMEPIZOLE PER 15MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1451", "type": "HCPCS"}, {"code": "5320731", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 12.96, "maximum": 14.4, "gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOT 2 VIEWS", "code_information": [{"code": "73620", "type": "CPT"}, {"code": "4903620", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 234.15, "gross_charge": 1115.0, "discounted_cash": 836.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 234.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOT 2 VIEWS", "code_information": [{"code": "73620", "type": "CPT"}, {"code": "5013620", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 234.15, "gross_charge": 1115.0, "discounted_cash": 836.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 234.15, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOT 3 VIEWS MINIMUM", "code_information": [{"code": "73630", "type": "CPT"}, {"code": "4903630", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 336.42, "gross_charge": 1602.0, "discounted_cash": 1201.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 336.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 70.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOT 3 VIEWS MINIMUM", "code_information": [{"code": "73630", "type": "CPT"}, {"code": "5013630", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 336.42, "gross_charge": 1602.0, "discounted_cash": 1201.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 336.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 70.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED 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"code_information": [{"code": "504", "type": "MS-DRG"}], "standard_charges": [{"minimum": 62061.18, "maximum": 78205.46, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 62061.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 78205.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH MCC", "code_information": [{"code": "503", "type": "MS-DRG"}], "standard_charges": [{"minimum": 92670.1, "maximum": 116776.83, "estimated_discounted_cash": 40074.65, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 92670.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 116776.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "505", "type": "MS-DRG"}], "standard_charges": [{"minimum": 59524.55, "maximum": 75008.96, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 59524.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 75008.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOREARM 2 VIEWS", "code_information": [{"code": "73090", "type": "CPT"}, {"code": "4903091", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 336.42, "gross_charge": 1602.0, "discounted_cash": 1201.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 336.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOREARM 2 VIEWS", "code_information": [{"code": "73090", "type": "CPT"}, {"code": "5013090", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 336.42, "gross_charge": 1602.0, "discounted_cash": 1201.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 336.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.5, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOREHEAD FLAP W/VASC PEDICLE", "code_information": [{"code": "15731", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FORENSIC AUTOPSY (NECROPSY)", "code_information": [{"code": "88040", "type": "CPT"}], "standard_charges": [{"minimum": 584.46, "maximum": 584.46, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 584.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 584.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORENSIC CYTOPATHOLOGY", "code_information": [{"code": "88125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"FORMOTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7640", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.75, "maximum": 1.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORMOTEROL FUMARATE, INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7606", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.46, "maximum": 2.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSCARNET SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1455", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.47, "maximum": 16.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSFOMYCIN 3GM PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305239", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 336.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FOSFOMYCIN 3GM PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305239", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 336.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FOSPHENYTOIN PER 50MG IJ", "code_information": [{"code": "Q2009", "type": "HCPCS"}, {"code": "5320749", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 14.91, "maximum": 14.91, "gross_charge": 71.0, "discounted_cash": 53.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 14.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSPHENYTOIN PER 50MG IJ", "code_information": [{"code": "Q2009", "type": "HCPCS"}, {"code": "5320749", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 14.91, "maximum": 14.91, "gross_charge": 71.0, "discounted_cash": 53.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 14.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTIONATION KETOSTEROIDS", "code_information": [{"code": "83593", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 134.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 134.14, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [{"code": "562", "type": "MS-DRG"}], "standard_charges": [{"minimum": 47306.21, "maximum": 59612.21, "estimated_discounted_cash": 81638.42, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47306.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 59612.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [{"code": "563", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29732.39, "maximum": 37466.82, "estimated_discounted_cash": 53744.75, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29732.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37466.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITH MCC", "code_information": [{"code": "533", "type": "MS-DRG"}], "standard_charges": [{"minimum": 52050.78, "maximum": 65591.0, "estimated_discounted_cash": 86529.48, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 52050.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 65591.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [{"code": "534", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26764.13, "maximum": 33726.42, "estimated_discounted_cash": 95138.7, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26764.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33726.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [{"code": "535", "type": "MS-DRG"}], "standard_charges": [{"minimum": 42564.96, "maximum": 53637.6, "estimated_discounted_cash": 97218.92, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42564.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 53637.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [{"code": "536", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26813.94, "maximum": 33789.18, "estimated_discounted_cash": 70807.22, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26813.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33789.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRAGMENTING OF KIDNEY STONE", "code_information": [{"code": "50590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 24307.0, "estimated_discounted_cash": 59205.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7467.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1855.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21875.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24307.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1855.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1855.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1855.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1855.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRANCISELLA TULARENS AB", "code_information": [{"code": "86668", "type": "CPT"}, {"code": "7258666", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.03, "gross_charge": 129.0, "discounted_cash": 96.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 53.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE FASCIAL FLAP MICROVASC", "code_information": [{"code": "15758", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2281.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2281.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2281.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2281.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2281.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREE JEJUNUM FLAP MICROVASC", "code_information": [{"code": "43496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREE MYO/SKIN FLAP MICROVASC", "code_information": [{"code": "15756", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2293.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2293.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2293.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2293.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2293.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREE OMENTAL FLAP MICROVASC", "code_information": [{"code": "49906", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREE SKIN FLAP MICROVASC", "code_information": [{"code": "15757", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2287.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2287.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2287.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2287.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2287.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREE/REMOVE CHEST LINING", "code_information": [{"code": "32320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1572.33, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1572.33, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1572.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1572.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1572.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREEING OF BOWEL ADHESION", "code_information": [{"code": "44005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 998.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 998.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 998.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 998.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 998.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRENULOTOMY OF PENIS", "code_information": [{"code": "54164", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRONTIER EXTENDED STAY DEMO", "code_information": [{"code": "G9140", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD FREEZE/THAW", "code_information": [{"code": "86932", "type": "CPT"}], "standard_charges": [{"minimum": 33.84, "maximum": 33.84, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD PREP", "code_information": [{"code": "86930", "type": "CPT"}], "standard_charges": [{"minimum": 291.26, "maximum": 291.26, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD THAW", "code_information": [{"code": "86931", "type": "CPT"}], "standard_charges": [{"minimum": 291.26, "maximum": 291.26, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN CELL PREPARATION", "code_information": [{"code": "88241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.5, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN IVF CASE RATE", "code_information": [{"code": "S4016", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FRUC SEMEN QT", "code_information": [{"code": "82757", "type": "CPT"}, {"code": "7252757", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 88.48, "gross_charge": 254.0, "discounted_cash": 190.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 88.48, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GR F/C/C/M/N/AX/G/H/F EA", "code_information": [{"code": "15241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GR FR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "15240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR N/E/E/L 20 SQCM/<", "code_information": [{"code": "15260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR N/E/E/L EACH ADDL", "code_information": [{"code": "15261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR S/A/L 20 SQ CM/<", "code_information": [{"code": "15220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 21860.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR S/A/L EACH ADDL", "code_information": [{"code": "15221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR TRNK 20 SQ CM/<", "code_information": [{"code": "15200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR TRNK EACH ADDL", "code_information": [{"code": "15201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTL ANEUP DNA SEQ CMPR ALYS", "code_information": [{"code": "341U", "type": "CPT"}], "standard_charges": [{"minimum": 1900.2, "maximum": 1900.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1900.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1900.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY STR ALYS DNA", "code_information": [{"code": "252U", "type": "CPT"}], "standard_charges": [{"minimum": 759.05, "maximum": 759.05, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 759.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 759.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY TRSMY DNA SEQ", "code_information": [{"code": "327U", "type": "CPT"}], "standard_charges": [{"minimum": 795.0, "maximum": 795.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 795.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 795.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR 3 PROTEINS", "code_information": [{"code": "81509", "type": "CPT"}], "standard_charges": [{"minimum": 1487.37, "maximum": 1487.37, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1487.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1487.37, "methodology": "fee 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OPTIONS", "standard_charge_dollar": 153.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR THREE ANAL", "code_information": [{"code": "81510", "type": "CPT"}], "standard_charges": [{"minimum": 55.54, "maximum": 55.54, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR TWO PROTEINS", "code_information": [{"code": "81508", "type": "CPT"}], "standard_charges": [{"minimum": 54.3, "maximum": 54.3, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL FIELD ERG W/I&R", "code_information": [{"code": "92273", "type": "CPT"}], "standard_charges": [{"minimum": 343.64, "maximum": 392.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL LENGTH SURG STOCKING", "code_information": [{"code": "A4510", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FULL MOUTH X-RAY OF TEETH", "code_information": [{"code": "70320", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 230.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 107.87, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 53.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 53.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 53.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 53.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 53.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [{"code": "793", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30.0, "maximum": 79658.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18693.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71692.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24794.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36742.85, "methodology": "case rate"}, {"payer_name": "BLUE 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27549.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40825.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20770.66, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 48938.63, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 15910.63, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11258.51, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 24606.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4743.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5978.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC", "code_information": [{"code": "928", "type": "MS-DRG"}], "standard_charges": [{"minimum": 238147.99, "maximum": 300098.6, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 238147.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 300098.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC", "code_information": [{"code": "929", "type": "MS-DRG"}], "standard_charges": [{"minimum": 106937.0, "maximum": 134755.05, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 106937.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134755.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [{"code": "934", "type": "MS-DRG"}], "standard_charges": [{"minimum": 73396.34, "maximum": 92489.29, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 73396.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 92489.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULVESTRANT PER 25MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9395", "type": "HCPCS"}, {"code": "5320762", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 6.06, "maximum": 6.73, "gross_charge": 215.0, "discounted_cash": 161.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER 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"standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNDUS PHOTOGRAPHY W/I&R", "code_information": [{"code": "92250", "type": "CPT"}], "standard_charges": [{"minimum": 80.52, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 80.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 80.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 80.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 80.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 80.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGUS AB NES", "code_information": [{"code": "86671", "type": "CPT"}, {"code": "7256671", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.52, "gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGUS AB NES/2", "code_information": [{"code": "86671", "type": "CPT"}, {"code": "7256672", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.52, "gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGUS AB NES/4", "code_information": [{"code": "86671", "type": "CPT"}, {"code": "7256696", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.52, "gross_charge": 203.0, "discounted_cash": 152.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGUS AB NES/5", "code_information": [{"code": "86671", "type": "CPT"}, {"code": "7256736", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.52, "gross_charge": 202.0, "discounted_cash": 151.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305279", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FUROSEMIDE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305279", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FUROSEMIDE 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305283", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FUROSEMIDE 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305283", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FUROSEMIDE 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305287", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FUROSEMIDE 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305287", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FUROSEMIDE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1938", "type": "HCPCS"}, {"code": "5320822", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.02, "maximum": 0.02, "gross_charge": 0.12, "discounted_cash": 0.09, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1938", "type": "HCPCS"}, {"code": "5320822", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.02, "maximum": 0.02, "gross_charge": 0.12, "discounted_cash": 0.09, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE10MG/ML10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315247", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FUROSEMIDE10MG/ML10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315247", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FUROSEMIDE10MG/ML60ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315244", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FUROSEMIDE10MG/ML60ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315244", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1954.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1954.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1954.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1954.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1954.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2126.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2126.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2126.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2126.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2126.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2743.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2743.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2743.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2743.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2743.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & INTESTINE", "code_information": [{"code": "43340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1274.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1274.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1274.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1274.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1274.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & INTESTINE", "code_information": [{"code": "43341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1363.29, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1363.29, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1363.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1363.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1363.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & STOMACH", "code_information": [{"code": "43320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1283.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1283.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1283.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1283.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1283.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1034.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1034.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1034.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1034.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1034.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1177.29, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1177.29, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1177.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1177.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1177.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47741", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1333.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1333.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1333.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1333.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1333.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE HAND BONES WITH GRAFT", "code_information": [{"code": "25825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE LIVER DUCT & INTESTINE", "code_information": [{"code": "47802", "type": "CPT"}], "standard_charges": [{"minimum": 1378.03, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1378.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1378.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1378.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1378.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1378.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE LIVER DUCTS & BOWEL", "code_information": [{"code": "47765", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2513.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2513.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2513.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2513.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2513.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS AND BOWEL", "code_information": [{"code": "48548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1514.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1514.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1514.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1514.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1514.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 989.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 989.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 989.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 989.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 989.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1190.53, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1190.53, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1190.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1190.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1190.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE UPPER GI STRUCTURES", "code_information": [{"code": "47721", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1215.74, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1215.74, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1215.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1215.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1215.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE/GRAFT ADDED JOINT", "code_information": [{"code": "26863", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION 2 OR MORE 3D IMAGES", "code_information": [{"code": "D0395", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF ANKLE JOINT OPEN", "code_information": [{"code": "27870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 33800.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF ELBOW JOINT", "code_information": [{"code": "24800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FACIAL/OTHER NERVE", "code_information": [{"code": "64866", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1190.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1190.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1190.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1190.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1190.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FACIAL/OTHER NERVE", "code_information": [{"code": "64868", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1036.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1036.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1036.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1036.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1036.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JNT ADD-ON", "code_information": [{"code": "26861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JOINT", "code_information": [{"code": "26860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JOINTS", "code_information": [{"code": "C7506", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER TENDONS", "code_information": [{"code": "26471", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER TENDONS", "code_information": [{"code": "26474", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28735", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 302450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF HAND BONES", "code_information": [{"code": "25820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF HAND JOINT", "code_information": [{"code": "26843", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNEE", "code_information": [{"code": "27580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1436.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1436.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1436.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1436.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1436.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE", "code_information": [{"code": "26850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINT", "code_information": [{"code": "26516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINTS", "code_information": [{"code": "26517", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINTS", "code_information": [{"code": "26518", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE WITH GRAFT", "code_information": [{"code": "26852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF SKULL ARTERIES", "code_information": [{"code": "61711", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2467.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2467.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2467.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2467.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2467.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF SPERMATIC DUCTS", "code_information": [{"code": "54900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF SPERMATIC DUCTS", "code_information": [{"code": "54901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 915.29, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 915.29, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 915.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 915.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 915.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1159.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1159.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1159.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1159.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1159.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1181.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1181.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1181.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1181.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1181.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF THUMB", "code_information": [{"code": "26841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF TIBIOFIBULAR JOINT", "code_information": [{"code": "27871", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF TOES", "code_information": [{"code": "28280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & BOWEL", "code_information": [{"code": "50810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.12, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.12, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", "code_information": [{"code": "50740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1123.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1123.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1123.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1123.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1123.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", "code_information": [{"code": "50750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1199.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1199.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1199.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1199.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1199.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETERS", "code_information": [{"code": "50760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1130.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1130.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1130.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1130.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1130.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF WRIST JOINT", "code_information": [{"code": "25800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION RADIOULNAR JNT/ULNA", "code_information": [{"code": "25830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF ELBOW JOINT", "code_information": [{"code": "24802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF FINGER JOINT", "code_information": [{"code": "26862", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF HAND JOINT", "code_information": [{"code": "26844", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF WRIST JOINT", "code_information": [{"code": "25805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF WRIST JOINT", "code_information": [{"code": "25810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUT1 GNOTYP FUT1 EXON 4", "code_information": [{"code": "185U", "type": "CPT"}], "standard_charges": [{"minimum": 185.2, "maximum": 185.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUT2 GNOTYP FUT2 EXON 2", "code_information": [{"code": "186U", "type": "CPT"}], "standard_charges": [{"minimum": 185.2, "maximum": 185.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR 1ST 100 SQ CM", "code_information": [{"code": "479T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR EA ADDL 100SQCM", "code_information": [{"code": "480T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FXN GENE ANALYSIS", "code_information": [{"code": "233U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE CHARAC ALLELES", "code_information": [{"code": "81285", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE DETC ABNOR ALLELES", "code_information": [{"code": "81284", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE FULL GENE SEQUENCE", "code_information": [{"code": "81286", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE KNOWN FAMIL VARIANT", "code_information": [{"code": "81289", "type": "CPT"}], "standard_charges": [{"minimum": 185.2, "maximum": 185.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FY GNOTYP ACKR1 EXONS 1-2", "code_information": [{"code": "187U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Factor ix recombinant", "code_information": [{"code": "C9133", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Fecal dna analysis", "code_information": [{"code": "S3890", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ferric citrate, oral, 3 mg ferric iron, (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0609", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.11, "maximum": 0.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS FOR OBESITY", "code_information": [{"code": "43846", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS INCL SMALL I", "code_information": [{"code": "43847", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1627.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1627.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1627.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1627.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1627.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMP SM BOWEL", "code_information": [{"code": "78265", "type": "CPT"}, {"code": "5208265", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1346.14, "gross_charge": 5813.0, "discounted_cash": 4359.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1220.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1346.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 495.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 481.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 550.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 550.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 550.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING STUDY", "code_information": [{"code": "78264", "type": "CPT"}, {"code": "5208276", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 980.7, "gross_charge": 4670.0, "discounted_cash": 3502.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 980.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 620.92, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 300.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 300.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 300.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 300.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 300.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC MOTILITY STUDIES", "code_information": [{"code": "91020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 268.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 268.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 268.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 268.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 268.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIC MUCOSA IMAGING", "code_information": [{"code": "78261", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 585.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 585.8, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 269.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 269.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 269.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 269.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 269.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC SM BOWEL+COL", "code_information": [{"code": "78266", "type": "CPT"}, {"code": "5208266", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1698.63, "gross_charge": 7712.0, "discounted_cash": 5784.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1698.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIN", "code_information": [{"code": "82941", "type": "CPT"}, {"code": "7252941", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 89.94, "gross_charge": 233.0, "discounted_cash": 174.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 89.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIN TEST", "code_information": [{"code": "82938", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 90.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROESOPH REFLUX STUDY", "code_information": [{"code": "78262", "type": "CPT"}, {"code": "5208278", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 598.35, "gross_charge": 2300.0, "discounted_cash": 1725.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 598.35, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 270.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 270.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 270.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 270.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 270.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL FAT ABSORPT", "code_information": [{"code": "S3708", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [{"code": "378", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32561.2, "maximum": 41031.51, "estimated_discounted_cash": 68859.09, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32561.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41031.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [{"code": "377", "type": "MS-DRG"}], "standard_charges": [{"minimum": 60693.26, "maximum": 76481.69, "estimated_discounted_cash": 98822.35, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 60693.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 76481.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "379", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20930.54, "maximum": 26375.31, "estimated_discounted_cash": 29717.69, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20930.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26375.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [{"code": "389", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26222.94, "maximum": 33044.44, "estimated_discounted_cash": 62939.7, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26222.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33044.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [{"code": "388", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49032.71, "maximum": 61787.84, "estimated_discounted_cash": 88855.01, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49032.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61787.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC", "code_information": [{"code": "390", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18061.89, "maximum": 22760.42, "estimated_discounted_cash": 39706.78, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18061.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22760.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2201.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2201.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2201.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2201.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2201.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2494.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2494.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2494.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2494.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2494.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY DUODENAL SWITCH", "code_information": [{"code": "43845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1797.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1797.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1797.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1797.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1797.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY W/O V-BAND", "code_information": [{"code": "43843", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1152.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1152.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1152.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1152.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1152.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GATED HEART PLANAR MULT", "code_information": [{"code": "78473", "type": "CPT"}, {"code": "5208408", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1072.26, "gross_charge": 5106.0, "discounted_cash": 3829.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1072.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1013.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 445.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 445.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 445.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 445.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 445.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GATED HEART PLANAR SNGL", "code_information": [{"code": "78472", "type": "CPT"}, {"code": "5208402", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1193.22, "gross_charge": 5682.0, "discounted_cash": 4261.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1193.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 730.05, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 317.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 317.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 317.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 317.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 317.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GBA ANLS COMMON VARIANT", "code_information": [{"code": "81251", "type": "CPT"}, {"code": "7251251", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 47.25, "maximum": 47.25, "gross_charge": 1795.0, "discounted_cash": 1346.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GC CHL SYP DOCUMENTED", "code_information": [{"code": "G9228", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GC DNA AMP PROBE", "code_information": [{"code": "87591", "type": "CPT"}, {"code": "4107592", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "gross_charge": 646.0, "discounted_cash": 484.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GC DNA AMP PROBE", "code_information": [{"code": "87591", "type": "CPT"}, {"code": "7257592", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "gross_charge": 686.0, "discounted_cash": 514.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GC DNA AMP PROBE/2", "code_information": [{"code": "87591", "type": "CPT"}, {"code": "7257591", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "gross_charge": 202.0, "discounted_cash": 151.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GC STOCKING GARTER BELT", "code_information": [{"code": "A6544", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GCATH CRDS VISTABRITE", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "8241074", "type": "CDM"}], "standard_charges": [{"minimum": 45.57, "maximum": 45.57, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 45.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GCATH CRDS VISTABRT TP 8", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "8241078", "type": "CDM"}], "standard_charges": [{"minimum": 68.04, "maximum": 68.04, "gross_charge": 324.0, "discounted_cash": 243.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 68.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GCATH MACH 1", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "8241085", "type": "CDM"}], "standard_charges": [{"minimum": 55.86, "maximum": 55.86, "gross_charge": 266.0, "discounted_cash": 199.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 55.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GCATH RUNWAY 6F", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "8241097", "type": "CDM"}], "standard_charges": [{"minimum": 63.21, "maximum": 63.21, "gross_charge": 301.0, "discounted_cash": 225.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 63.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GDE LUNDERQUIST", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 130.2, "maximum": 130.2, "gross_charge": 620.0, "discounted_cash": 465.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 130.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GDE MICROWR APPROACH CTO", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073034", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 164.22, "maximum": 164.22, "gross_charge": 782.0, "discounted_cash": 586.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 164.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GDE SAVARY GIL", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 150.78, "maximum": 150.78, "gross_charge": 718.0, "discounted_cash": 538.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 150.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GDE SINUS CORON WORLEY", "code_information": [{"code": "C1892", "type": "HCPCS"}, {"code": "8182407", "type": "CDM"}], "standard_charges": [{"minimum": 356.16, "maximum": 356.16, "gross_charge": 1696.0, "discounted_cash": 1272.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 356.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GE GNOTYP GYPC EXONS 1-4", "code_information": [{"code": "188U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GEFITINIB ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8565", "type": "HCPCS"}], "standard_charges": [{"minimum": 143.86, "maximum": 159.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 143.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 159.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 159.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 159.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 159.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GEL-ONE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7326", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.33, "maximum": 529.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 476.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 529.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 529.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 529.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 529.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GEMFIBROZIL 600MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305311", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GEMFIBROZIL 600MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305311", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GEMTUZUMAB OZOGAMICIN 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9203", "type": "HCPCS"}], "standard_charges": [{"minimum": 212.96, "maximum": 236.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 212.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 236.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 236.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 236.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 236.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GEN ANES W/RAD EA ADD15", "code_information": [{"code": "3700023", "type": "CDM"}, {"code": "371", "type": "RC"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 843.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GEN ANES W/RAD INIT 30MIN", "code_information": [{"code": "3700020", "type": "CDM"}, {"code": "371", "type": "RC"}], "standard_charges": [{"gross_charge": 2251.0, "discounted_cash": 1688.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GEN NSTIM INTERSTIM 3058", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "4021480", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17593.17, "maximum": 17593.17, "gross_charge": 83777.0, "discounted_cash": 62832.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 17593.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GEN NSTIM PULSE PROCLAIM 3664", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "4008533", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 30426.9, "maximum": 30426.9, "gross_charge": 144890.0, "discounted_cash": 108667.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 30426.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE PROFILE PANEL BREAST", "code_information": [{"code": "S3854", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TEST ALPHA-THALASSEMIA", "code_information": [{"code": "S3845", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TEST BETA-THALASSEMIA", "code_information": [{"code": "S3846", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TEST HIPPEL-LINDAU", "code_information": [{"code": "S3842", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TEST MYO MUSCLR DYST", "code_information": [{"code": "S3853", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENE TEST SICKLE CELL", "code_information": [{"code": "S3850", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENERAL HEALTH PANEL", "code_information": [{"code": "80050", "type": "CPT"}], "standard_charges": [{"minimum": 45.36, "maximum": 45.36, "estimated_discounted_cash": 495.34, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 45.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENETIC COUNSEL 15 MINS", "code_information": [{"code": "S0265", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENETIC COUNSELING 30 MIN", "code_information": [{"code": "96040", "type": "CPT"}], "standard_charges": [{"minimum": 45.41, "maximum": 45.41, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.41, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENETIC TEST BRUGADA", "code_information": [{"code": "S3861", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GENETIC TESTING ALS", "code_information": [{"code": "S3800", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENETIC TSTG SEVERE INH COND", "code_information": [{"code": "81443", "type": "CPT"}], "standard_charges": [{"minimum": 2448.56, "maximum": 2448.56, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2448.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2448.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENOM RPD SEQ ALYS EA CMPRTR", "code_information": [{"code": "425U", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENOME RAPID SEQUENCE ALYS", "code_information": [{"code": "94U", "type": "CPT"}], "standard_charges": [{"minimum": 7582.2, "maximum": 7582.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7582.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7582.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENOME RE-EVALUATION", "code_information": [{"code": "81427", "type": "CPT"}], "standard_charges": [{"minimum": 2337.65, "maximum": 2337.65, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2337.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2337.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENOME SEQUENCE ANALYSIS", "code_information": [{"code": "81425", "type": "CPT"}], "standard_charges": [{"minimum": 5031.2, "maximum": 5031.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5031.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5031.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENOME SEQUENCE ANALYSIS", "code_information": [{"code": "81426", "type": "CPT"}], "standard_charges": [{"minimum": 2709.95, "maximum": 2709.95, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2709.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2709.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENOME ULTRA-RAPID SEQ ALYS", "code_information": [{"code": "426U", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENTAMICIN", "code_information": [{"code": "80170", "type": "CPT"}, {"code": "4103004", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.59, "gross_charge": 337.0, "discounted_cash": 252.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENTAMICIN/2", "code_information": [{"code": "80170", "type": "CPT"}, {"code": "4103009", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.59, "gross_charge": 225.0, "discounted_cash": 168.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.59, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENTAMICIN/3", "code_information": [{"code": "80170", "type": "CPT"}, {"code": "4103012", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.59, "gross_charge": 225.0, "discounted_cash": 168.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENVISC 850, INJ, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7320", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.19, "maximum": 5.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GF/CODEINE10-100/5 10LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315290", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GF/CODEINE10-100/5 10LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315290", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GF/CODEINE10-100/5 5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315288", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GF/CODEINE10-100/5 5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315288", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GFRG AUTOL FAT LIPO EA ADDL", "code_information": [{"code": "15774", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"billing_class": "facility"}]}, {"description": "GFT EPIDRML TRNK 1ST 100", "code_information": [{"code": "6909898", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 6213.0, "discounted_cash": 4659.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GGT", "code_information": [{"code": "82977", "type": "CPT"}, {"code": "4102980", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36.72, "gross_charge": 219.0, "discounted_cash": 164.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 36.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GGT", "code_information": [{"code": "82977", "type": "CPT"}, {"code": "7252980", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36.72, "gross_charge": 45.0, "discounted_cash": 33.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 36.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI BARET ESPH DNA MTHYLN ALY", "code_information": [{"code": "407U", "type": "CPT"}], "standard_charges": [{"minimum": 950.0, "maximum": 950.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 950.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 950.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI BARET ESPH DNA MTHYLN ALY", "code_information": [{"code": "409U", "type": "CPT"}], "standard_charges": [{"minimum": 2919.6, "maximum": 2919.6, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2919.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2919.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI BARRETT ESOPH 9 PRTN BMRK", "code_information": [{"code": "108U", "type": "CPT"}], "standard_charges": [{"minimum": 2513.25, "maximum": 2513.25, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2513.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2513.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI BARRETTS ESOPH VIM&CCNA1", "code_information": [{"code": "114U", "type": "CPT"}], "standard_charges": [{"minimum": 1938.01, "maximum": 1938.01, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1938.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1938.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI COCKTAIL LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315254", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GI COCKTAIL LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315254", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GI ENDOSCOPIC ULTRASOUND", "code_information": [{"code": "76975", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 230.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 112.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 112.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI MALABS AAT CALPRO PNCRTC", "code_information": [{"code": "430U", "type": "CPT"}], "standard_charges": [{"minimum": 61.54, "maximum": 61.54, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 61.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI PATHOGEN 12-15 AMP PROBE", "code_information": [{"code": "87507", "type": "CPT"}, {"code": "7257508", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2128.5, "gross_charge": 3091.0, "discounted_cash": 2318.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2128.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI PROTEIN LOSS EXAM", "code_information": [{"code": "78282", "type": "CPT"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", 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6938.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GI SURG LVL III EA ADD15", "code_information": [{"code": "5073555", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"gross_charge": 1573.0, "discounted_cash": 1179.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GI SURG LVL III INT 30M", "code_information": [{"code": "5073554", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"gross_charge": 7611.0, "discounted_cash": 5708.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GI TUBE INTRO W/FLUORO", "code_information": [{"code": "74340", "type": "CPT"}, {"code": "4904340", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 323.61, "gross_charge": 1541.0, "discounted_cash": 1155.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 323.61, "methodology": 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"standard_charge_dollar": 1186.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GIARDIA DFA", "code_information": [{"code": "87269", "type": "CPT"}, {"code": "4106919", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 222.0, "discounted_cash": 166.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER 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[{"code": "87329", "type": "CPT"}, {"code": "4107328", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 59.0, "discounted_cash": 44.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GIARDIA IA", "code_information": [{"code": "87329", "type": "CPT"}, {"code": "7250143", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 59.0, "discounted_cash": 44.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US 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"standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GIARDIA LAMBLIA AB", "code_information": [{"code": "86674", "type": "CPT"}, {"code": "7256674", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 75.04, "gross_charge": 303.0, "discounted_cash": 227.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 75.04, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GINTRO AGILIS STRB NPEEL", "code_information": [{"code": "C1766", "type": "HCPCS"}, {"code": "8241099", "type": "CDM"}], "standard_charges": [{"minimum": 724.29, "maximum": 724.29, "gross_charge": 3449.0, "discounted_cash": 2586.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 724.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GINTRO RAMP", "code_information": [{"code": "C1893", "type": "HCPCS"}, {"code": "8241160", "type": "CDM"}], "standard_charges": [{"minimum": 186.69, "maximum": 186.69, "gross_charge": 889.0, "discounted_cash": 666.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 186.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GINTRO SWARTZ", "code_information": [{"code": "C1893", "type": "HCPCS"}, {"code": "8241178", "type": "CDM"}], "standard_charges": [{"minimum": 404.46, "maximum": 404.46, "gross_charge": 1926.0, "discounted_cash": 1444.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 404.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GJB2 GENE FULL SEQUENCE", "code_information": [{"code": "81252", "type": "CPT"}], "standard_charges": [{"minimum": 101.12, "maximum": 101.12, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 101.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 101.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GJB2 GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81253", "type": "CPT"}], "standard_charges": [{"minimum": 61.52, "maximum": 61.52, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 61.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GJB6 GENE COM VARIANTS", "code_information": [{"code": "81254", "type": "CPT"}], "standard_charges": [{"minimum": 35.0, "maximum": 35.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLASSIA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0257", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.08, "maximum": 5.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLATIRAMR ACET PER20MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1595", "type": "HCPCS"}, {"code": "5320884", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 64.13, "maximum": 71.25, "gross_charge": 275.0, "discounted_cash": 206.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 64.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 71.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 71.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 71.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 71.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLATIRAMR ACET PER20MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1595", "type": "HCPCS"}, {"code": "5320884", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 64.13, "maximum": 71.25, "gross_charge": 275.0, "discounted_cash": 206.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 64.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 71.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 71.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 71.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 71.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SCRN HGH RISK DIREC", "code_information": [{"code": "G0117", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SCRN HGH RISK DIREC", "code_information": [{"code": "G0118", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLENOID PEG KEEL HYB DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 598.71, "maximum": 598.71, "gross_charge": 2851.0, "discounted_cash": 2138.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 598.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013171", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1437.03, "maximum": 1437.03, "gross_charge": 6843.0, "discounted_cash": 5132.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1437.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE INHANCE DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013181", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1423.8, "maximum": 1423.8, "gross_charge": 6780.0, "discounted_cash": 5085.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1423.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE STRYKER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1355.76, "maximum": 1355.76, "gross_charge": 6456.0, "discounted_cash": 4842.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1355.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIADIAN ANTIBODY", "code_information": [{"code": "86258", "type": "CPT"}, {"code": "7253717", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIADIN AB", "code_information": [{"code": "86258", "type": "CPT"}, {"code": "7253508", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIADIN AB/2", "code_information": [{"code": "86258", "type": "CPT"}, {"code": "7254213", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIMEPIRIDE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305320", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIMEPIRIDE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305320", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIPIZIDE 2.5MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305344", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIPIZIDE 2.5MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305344", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIPIZIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305345", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIPIZIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305345", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIPIZIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305346", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIPIZIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305346", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOBAL ESWL KIDNEY", "code_information": [{"code": "S0400", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 24307.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21875.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24307.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUC MONITOR PURCHASE", "code_information": [{"code": "S1030", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLUC MONITOR RENTAL", "code_information": [{"code": "S1031", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLUCAGON", "code_information": [{"code": "82943", "type": "CPT"}, {"code": "7252943", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.89, "gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 72.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee 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"maximum": 148.47, "gross_charge": 707.0, "discounted_cash": 530.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 148.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT HAND OR FINGER TENDON", "code_information": [{"code": "26416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFT REPAIR OF SPINE DEFECT", "code_information": [{"code": "63710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1043.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1043.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1043.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1043.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1043.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFT STNT AAA BIFURCATD", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4011500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17444.28, "maximum": 17444.28, "gross_charge": 83068.0, "discounted_cash": 62301.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 17444.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT TENDON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "8151555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2722.86, "maximum": 2722.86, "gross_charge": 12966.0, "discounted_cash": 9724.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2722.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT VASC ARTEGRAFT", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8142136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2789.43, "maximum": 2789.43, "gross_charge": 13283.0, "discounted_cash": 9962.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2789.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTJACKET PER SQ CM", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "4032506", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2952.18, "maximum": 2952.18, "gross_charge": 14058.0, "discounted_cash": 10543.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2952.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTJACKET PER SQ CM", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "4032506", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2952.18, "maximum": 2952.18, "gross_charge": 14058.0, "discounted_cash": 10543.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2952.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAM STAIN SMEAR", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "4107205", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.75, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAM STAIN SMEAR/4", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "4108705", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.75, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRANISETRON 1MG", "code_information": [{"code": "S0091", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.08, "maximum": 3.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRANISETRON HCL 1 MG ORAL", "code_information": [{"code": "Q0166", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GREAT TOE-HAND TRANSFER", "code_information": [{"code": "26551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3028.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3028.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3028.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3028.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3028.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO 25 CC/<", "code_information": [{"code": "15773", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO 50 CC/<", "code_information": [{"code": "15771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 28184.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO EA ADDL", "code_information": [{"code": "15772", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL SOFT TISS DIR EXC", "code_information": [{"code": "15769", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFT ALLOMAX 5X8CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4021488", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1222.62, "maximum": 1222.62, "gross_charge": 5822.0, "discounted_cash": 4366.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1222.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT ALLOMAX SURGICAL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4021494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 244.44, "maximum": 244.44, "gross_charge": 1164.0, "discounted_cash": 873.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT AORTOILIAC ARTERY", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4021701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4518.78, "maximum": 4518.78, "gross_charge": 21518.0, "discounted_cash": 16138.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4518.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT CNTRLTRL LEG", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4022321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6053.67, "maximum": 6053.67, "gross_charge": 28827.0, "discounted_cash": 21620.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6053.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT CORTICAL FIBER INCITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4021707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1061.34, "maximum": 1061.34, "gross_charge": 5054.0, "discounted_cash": 3790.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1061.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT DVF WOVN HEMASHIELD", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8246550", "type": "CDM"}], "standard_charges": [{"minimum": 568.05, "maximum": 568.05, "gross_charge": 2705.0, "discounted_cash": 2028.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 568.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT DVF WOVN HEMASHLD2", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4021490", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 675.99, "maximum": 675.99, "gross_charge": 3219.0, "discounted_cash": 2414.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 675.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT ENDOV AAA MAIN BODY", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT ENDOVS AAA CONVERTR", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT ENDV BF MN BDY ZTRK", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT EXT AORTIC CUF 3.75", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8142058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4246.2, "maximum": 4246.2, "gross_charge": 20220.0, "discounted_cash": 15165.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4246.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT ILIAC LEG AAA ZENTH", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028398", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT IPSLTRL LEG", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4022322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13377.42, "maximum": 13377.42, "gross_charge": 63702.0, "discounted_cash": 47776.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 13377.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT MESH MARLX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "8142080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1858.29, "maximum": 1858.29, "gross_charge": 8849.0, "discounted_cash": 6636.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1858.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT NERVE AVANCE", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4021702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10697.4, "maximum": 10697.4, "gross_charge": 50940.0, "discounted_cash": 38205.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 10697.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT PATCH DACRON", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8142116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 111.93, "maximum": 111.93, "gross_charge": 533.0, "discounted_cash": 399.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 111.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT PTCH", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8142125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2668.89, "maximum": 2668.89, "gross_charge": 12709.0, "discounted_cash": 9531.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2668.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT PV BYP DISTAFLO", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4022316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2874.06, "maximum": 2874.06, "gross_charge": 13686.0, "discounted_cash": 10264.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2874.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT SAPHENOUS 70-79CM", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4022004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11016.81, "maximum": 11016.81, "gross_charge": 52461.0, "discounted_cash": 39345.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 11016.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT SAPHNOUS OVER 80CM", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8141769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12728.31, "maximum": 12728.31, "gross_charge": 60611.0, "discounted_cash": 45458.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 12728.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT SAPHNOUS UP TO 60CM", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8141770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9792.51, "maximum": 9792.51, "gross_charge": 46631.0, "discounted_cash": 34973.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 9792.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT SAPHNOUS UP TO 70CM", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8141773", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13705.65, "maximum": 13705.65, "gross_charge": 65265.0, "discounted_cash": 48948.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 13705.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT SAPHNOUS UP TO 80CM", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8141771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13856.22, "maximum": 13856.22, "gross_charge": 65982.0, "discounted_cash": 49486.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 13856.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT STNT ENDOVASCULR", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028459", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT STNT TRNK IPSIL LEG", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4028452", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17472.84, "maximum": 17472.84, "gross_charge": 83204.0, "discounted_cash": 62403.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 17472.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT TUTOPLAST DERMIS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4022012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4653.18, "maximum": 4653.18, "gross_charge": 22158.0, "discounted_cash": 16618.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4653.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT VASC BIF D", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8142145", "type": "CDM"}, 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{"description": "GROUP BEHAVE COUNS 2-10", "code_information": [{"code": "G0473", "type": "HCPCS"}], "standard_charges": [{"minimum": 104.05, "maximum": 118.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 104.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 118.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 118.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 118.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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"plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 109.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 109.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 129.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 129.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE(HGH)", "code_information": [{"code": "83003", "type": "CPT"}, {"code": "7253003", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.01, "gross_charge": 146.0, "discounted_cash": 109.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 85.01, "methodology": "fee 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"gross_charge": 211.0, "discounted_cash": 158.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 44.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 148.47, "maximum": 148.47, "gross_charge": 707.0, "discounted_cash": 530.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 148.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073086", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 27.3, "maximum": 27.3, "gross_charge": 130.0, "discounted_cash": 97.5, "setting": "both", 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"gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW DOC WIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246630", "type": "CDM"}], "standard_charges": [{"minimum": 91.77, "maximum": 91.77, "gross_charge": 437.0, "discounted_cash": 327.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 91.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW DRILL TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 55.23, "maximum": 55.23, "gross_charge": 263.0, "discounted_cash": 197.25, "setting": "both", "payers_information": 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{"description": "GW GLIDEWIRE STIFF", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246669", "type": "CDM"}], "standard_charges": [{"minimum": 53.55, "maximum": 53.55, "gross_charge": 255.0, "discounted_cash": 191.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 53.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW GLIDEWIRE STIFF ANG", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246664", "type": "CDM"}], "standard_charges": [{"minimum": 59.22, "maximum": 59.22, "gross_charge": 282.0, "discounted_cash": 211.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 59.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW HI-TORQ BALANCE MW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241254", "type": "CDM"}], "standard_charges": [{"minimum": 91.77, "maximum": 91.77, "gross_charge": 437.0, "discounted_cash": 327.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 91.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW HI-TORQ IRONMAN", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241270", "type": "CDM"}], "standard_charges": [{"minimum": 91.77, "maximum": 91.77, "gross_charge": 437.0, "discounted_cash": 327.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 91.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW HI-TORQ WIGGLE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241310", "type": "CDM"}], "standard_charges": [{"minimum": 91.77, "maximum": 91.77, "gross_charge": 437.0, "discounted_cash": 327.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 91.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW HITORQ EX SUPPORT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246674", "type": "CDM"}], "standard_charges": [{"minimum": 91.77, "maximum": 91.77, "gross_charge": 437.0, "discounted_cash": 327.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 91.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW HP JAGWIRE SNGL USE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246725", "type": "CDM"}], "standard_charges": [{"minimum": 199.08, "maximum": 199.08, "gross_charge": 948.0, "discounted_cash": 711.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 199.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW J", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 125.58, "maximum": 125.58, "gross_charge": 598.0, "discounted_cash": 448.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 125.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW J TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073172", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 46.83, "maximum": 46.83, "gross_charge": 223.0, "discounted_cash": 167.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 46.83, "methodology": "fee 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PIGTAIL TRANSSEPT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 217.14, "maximum": 217.14, "gross_charge": 1034.0, "discounted_cash": 775.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 217.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW PTCA CHOICE 182/300", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241210", "type": "CDM"}], "standard_charges": [{"minimum": 77.28, "maximum": 77.28, "gross_charge": 368.0, "discounted_cash": 276.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 77.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW PTCA LUGE 182/300", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241212", "type": "CDM"}], "standard_charges": [{"minimum": 79.8, "maximum": 79.8, "gross_charge": 380.0, "discounted_cash": 285.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 79.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW PTCA PTGRPHX MED182/3", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241218", "type": "CDM"}], "standard_charges": [{"minimum": 77.28, "maximum": 77.28, "gross_charge": 368.0, "discounted_cash": 276.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 77.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW ST/JC", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 59.22, "maximum": 59.22, "gross_charge": 282.0, "discounted_cash": 211.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 59.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW STRI FIX CORE ALL", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073244", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 16.17, "maximum": 16.17, "gross_charge": 77.0, "discounted_cash": 57.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 16.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GW SUPER STIFF", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073247", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 129.99, "maximum": 129.99, "gross_charge": 619.0, "discounted_cash": 464.25, 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{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAIR TRNSPL 1-15 PUNCH GRFTS", "code_information": [{"code": "15775", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAIR TRNSPL >15 PUNCH GRAFTS", "code_information": [{"code": "15776", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL", "code_information": [{"code": "80173", "type": "CPT"}, {"code": "7250304", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.24, "gross_charge": 182.0, "discounted_cash": 136.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305610", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305610", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305626", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305626", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305614", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305614", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305618", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305618", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305622", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305622", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL2MG/ML 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315358", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL2MG/ML 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315358", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL2MG/ML 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315312", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL2MG/ML 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315312", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HAND 2 VIEWS", "code_information": [{"code": "73120", "type": "CPT"}, {"code": "4903120", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 238.56, "gross_charge": 1136.0, "discounted_cash": 852.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 238.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAND 2 VIEWS", "code_information": [{"code": "73120", "type": "CPT"}, {"code": "5013120", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 238.56, "gross_charge": 1136.0, "discounted_cash": 852.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 238.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAND 3 VIEWS MINIMUM", "code_information": [{"code": "73130", "type": "CPT"}, {"code": "4903130", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 379.05, "gross_charge": 1805.0, "discounted_cash": 1353.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 379.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 70.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE 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{"description": "HAND HELD NEB TREATMENT", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "5500122", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 16.25, "maximum": 298.43, "gross_charge": 615.0, "discounted_cash": 461.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 260.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC", "code_information": [{"code": "513", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9094.21, "maximum": 65867.14, "estimated_discounted_cash": 75581.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 55889.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21676.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34438.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18007.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18947.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22808.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 58809.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36236.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 20008.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38264.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 62100.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24085.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38264.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24085.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 62100.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 20008.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20008.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 62100.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24085.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38264.99, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9094.21, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 51432.99, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11850.79, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 18403.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 52269.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 65867.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "514", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8937.66, "maximum": 79293.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42697.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71363.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 22120.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14912.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23276.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 44928.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15691.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 75091.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 47442.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24578.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16569.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 79293.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 47442.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 79293.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16569.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24578.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 47442.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16569.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24578.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 79293.71, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 14680.42, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 67788.48, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8937.66, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 37383.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33942.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42772.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND PROCEDURES FOR INJURIES", "code_information": [{"code": "906", "type": "MS-DRG"}], "standard_charges": [{"minimum": 65218.69, "maximum": 82184.35, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 65218.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 82184.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND TENDON RECONSTRUCTION", "code_information": [{"code": "26500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND TENDON RECONSTRUCTION", "code_information": [{"code": "26502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND TENDON/MUSCLE TRANSFER", "code_information": [{"code": "26494", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAPTOGLOBIN QUANT", "code_information": [{"code": "83010", "type": "CPT"}, {"code": "4103010", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 64.17, "gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 64.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAPTOGLOBIN QUANT", "code_information": [{"code": "83010", "type": "CPT"}, {"code": "7253010", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 64.17, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 64.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAPTOGLOBIN QUANT/2", "code_information": [{"code": "83010", "type": "CPT"}, {"code": "7253011", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 64.17, "gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 64.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST ALLOGENEIC STEM CELL", "code_information": [{"code": "38205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST AUTO STEM CELLS", "code_information": [{"code": "38206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST CULTURED SKIN GRAFT", "code_information": [{"code": "15040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST EYE TISSUE ALOGRAFT", "code_information": [{"code": "68371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST FEMOROPOPLITEAL VEIN", "code_information": [{"code": "35572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 357.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 357.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 357.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 357.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 357.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST STEM CELL CONCENTRTE", "code_information": [{"code": "38215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST VEIN FOR BYPASS", "code_information": [{"code": "35500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 331.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 331.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 331.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 331.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 331.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVESTING OF DONOR MULTIVIS", "code_information": [{"code": "S2055", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAST STUDY", "code_information": [{"code": "94452", "type": "CPT"}, {"code": "5501220", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 64.26, "maximum": 165.85, "gross_charge": 1383.0, "discounted_cash": 1037.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 64.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 64.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 64.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 64.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 64.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAST W/OXYGEN TITRATE", "code_information": [{"code": "94453", "type": "CPT"}, {"code": "5504453", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 88.5, "maximum": 165.85, "gross_charge": 1383.0, "discounted_cash": 1037.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HB FUL BDY CHMBR P 30MIN", "code_information": [{"code": "G0277", "type": "HCPCS"}, {"code": "6900020", "type": "CDM"}, {"code": "413", "type": "RC"}], "standard_charges": [{"minimum": 155.81, "maximum": 178.18, "gross_charge": 864.0, "discounted_cash": 648.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 160.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 155.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 178.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 178.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 178.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HB GLYCOSYLATED A1C HOME DEV", "code_information": [{"code": "83037", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBA 1/2 DELETES/VARIANTS/2", "code_information": [{"code": "81257", "type": "CPT"}, {"code": "7259209", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 102.26, "maximum": 102.26, "gross_charge": 5978.0, "discounted_cash": 4483.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 102.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 102.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 FULL GENE SEQUENCE", "code_information": [{"code": "81259", "type": "CPT"}], "standard_charges": [{"minimum": 600.0, "maximum": 600.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE DUP/DEL VRNTS", "code_information": [{"code": "81269", "type": "CPT"}], "standard_charges": [{"minimum": 202.4, "maximum": 202.4, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 202.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 202.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE FAM VRNT", "code_information": [{"code": "81258", "type": "CPT"}], "standard_charges": [{"minimum": 375.25, "maximum": 375.25, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 375.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 375.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBB FULL GENE SEQUENCE", "code_information": [{"code": "81364", "type": "CPT"}, {"code": "4100345", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 324.58, "maximum": 324.58, "gross_charge": 1102.0, "discounted_cash": 826.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 324.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 324.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HBB GENE COM VARIANTS", "code_information": [{"code": "81361", "type": "CPT"}], "standard_charges": [{"minimum": 174.81, "maximum": 174.81, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", 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"UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART IMAGE SPECT", "code_information": [{"code": "78494", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 839.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 839.18, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 366.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 366.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 366.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 366.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 366.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (3D)", "code_information": [{"code": "78469", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2113.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 707.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 313.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1902.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 313.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 313.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 313.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 313.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (EF)", "code_information": [{"code": "78468", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 782.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 543.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 259.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 704.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 782.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 782.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 782.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 782.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 259.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 259.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 259.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 259.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART PACING MAPPING", "code_information": [{"code": "93631", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10612.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART REVASCULARIZE (TMR)", "code_information": [{"code": "33140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1538.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1538.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1538.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1538.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1538.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART TMR W/OTHER PROCEDURE", "code_information": [{"code": "33141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 161.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 161.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 161.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 161.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 161.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC", "code_information": [{"code": "1", "type": "MS-DRG"}], "standard_charges": [{"minimum": 109049.68, "maximum": 1172491.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 118701.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 133692.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 159515.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH 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"code_information": [{"code": "83050", "type": "CPT"}, {"code": "4103050", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.34, "gross_charge": 118.0, "discounted_cash": 88.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 37.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMI-WHEELCHAIR DETACHABLE A", "code_information": [{"code": "E1086", "type": "HCPCS"}], "standard_charges": [{"minimum": 1672.18, "maximum": 1912.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1721.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1672.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1912.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1912.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1912.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMI-WHEELCHAIR FIXED ARMS", "code_information": [{"code": "E1085", "type": "HCPCS"}], "standard_charges": [{"minimum": 1372.68, "maximum": 1569.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1413.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1372.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1569.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1569.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1569.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMICRT INTRCLRY ALGRFT PRTL", "code_information": [{"code": "20933", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMIN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1640", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.76, "maximum": 34.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 34.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 34.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 34.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMO & AGGLU AUTO SCR EA", "code_information": [{"code": "86940", "type": "CPT"}, {"code": "7256940", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 41.83, "gross_charge": 180.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 41.83, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.46, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMO & AGGLU INCUBATED", "code_information": [{"code": "86941", "type": "CPT"}, {"code": "7258694", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.76, "gross_charge": 412.0, "discounted_cash": 309.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.76, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOCHROM COMMON VARIANT", "code_information": [{"code": "81256", "type": "CPT"}, {"code": "7251256", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 333.79, "gross_charge": 494.0, "discounted_cash": 370.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 333.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 65.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 65.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOCHROM COMMON VARIANT/2", "code_information": [{"code": "81256", "type": "CPT"}, {"code": "7259211", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 333.79, "gross_charge": 376.0, "discounted_cash": 282.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 333.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 65.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 65.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMODIAL RENL FAIL", "code_information": [{"code": "90935", "type": "CPT"}, {"code": "5600970", "type": "CDM"}, {"code": "801", "type": "RC"}], "standard_charges": [{"minimum": 70.47, "maximum": 952.79, "gross_charge": 4360.0, "discounted_cash": 3270.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 915.6, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 857.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 833.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMODIAL RENL FAIL", "code_information": [{"code": "90935", "type": "CPT"}, {"code": "5600970", "type": "CDM"}, {"code": "821", "type": "RC"}], "standard_charges": [{"minimum": 70.47, "maximum": 952.79, "gross_charge": 4360.0, "discounted_cash": 3270.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 915.6, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 857.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 833.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS REPEATED EVAL", "code_information": [{"code": "90937", "type": "CPT"}], "standard_charges": [{"minimum": 114.18, "maximum": 234.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 210.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 204.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 234.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 234.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 234.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN COPPER SULFATE", "code_information": [{"code": "83026", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3.3, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN F FETAL CHEMICAL", "code_information": [{"code": "83030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 42.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 42.19, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.56, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FRAC & QNT", "code_information": [{"code": "83021", "type": "CPT"}, {"code": "7253021", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.09, "gross_charge": 293.0, "discounted_cash": 219.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FTL F ASSAY QUAL", "code_information": [{"code": "83033", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN GLYCATED", "code_information": [{"code": "83036", "type": "CPT"}, {"code": "4102994", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.49, "gross_charge": 324.0, "discounted_cash": 243.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 49.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN PLASMA", "code_information": [{"code": "83051", "type": "CPT"}, {"code": "7253051", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.27, "gross_charge": 118.0, "discounted_cash": 88.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 37.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.21, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN THERMOLABILE", "code_information": [{"code": "83065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.11, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 35.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN URINE", "code_information": [{"code": "83069", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.11, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBN ELECTRPHORESIS", "code_information": [{"code": "83020", "type": "CPT"}, {"code": "7253023", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.66, "gross_charge": 167.0, "discounted_cash": 125.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOLYSIN ACID", "code_information": [{"code": "85475", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 45.26, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOPERFUSION", "code_information": [{"code": "90997", "type": "CPT"}], "standard_charges": [{"minimum": 91.32, "maximum": 91.32, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 91.32, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 91.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 91.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 91.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 91.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOPHILUS INFLUENZA AB", "code_information": [{"code": "86684", "type": "CPT"}, {"code": "7256193", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 80.81, "gross_charge": 324.0, "discounted_cash": 243.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 80.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDOPEXY BY STAPLING", "code_information": [{"code": "46947", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOSIDERIN QUAL", "code_information": [{"code": "83070", "type": "CPT"}, {"code": "7253070", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.24, "gross_charge": 82.0, "discounted_cash": 61.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOSTATS FOR DIALYSIS, EACH", "code_information": [{"code": "E1637", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, 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"HHCP-SERV OF OT,EA 15 MIN", "code_information": [{"code": "G0152", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHCP-SERV OF PT,EA 15 MIN", "code_information": [{"code": "G0151", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHCP-SVS OF AIDE,EA 15 MIN", "code_information": [{"code": "G0156", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHCP-SVS OF CSW,EA 15 MIN", "code_information": [{"code": "G0155", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHCP-SVS OF S/L PATH,EA 15MN", "code_information": [{"code": "G0153", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHN TX DEMO AND/OR EVAL", "code_information": [{"code": "94664", "type": "CPT"}, {"code": "5500120", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 17.77, "maximum": 298.43, "gross_charge": 615.0, "discounted_cash": 461.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 260.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HHN TX DEMO AND/OR EVAL", "code_information": [{"code": "94664", "type": "CPT"}, {"code": "6704664", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 17.77, "maximum": 298.43, "gross_charge": 1034.0, "discounted_cash": 775.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 260.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HHS/HOSPICE OF LPN EA 15 MIN", "code_information": [{"code": "G0300", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHS/HOSPICE OF RN EA 15 MIN", "code_information": [{"code": "G0299", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA DIR PROBE", "code_information": [{"code": "87531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 102.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 102.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 58.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 58.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA QUANT", "code_information": [{"code": "87533", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 212.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 212.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HI ENRGY ESWT PLANTAR FASCIA", "code_information": [{"code": "28890", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 189.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 189.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 189.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 189.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 189.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIB-HEPB VACCINE IM", "code_information": [{"code": "90748", "type": "CPT"}], "standard_charges": [{"minimum": 67.19, "maximum": 74.65, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 67.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIB-MENCY VACC 6WK-18M0 IM", "code_information": [{"code": "90644", "type": "CPT"}], "standard_charges": [{"minimum": 31.95, "maximum": 35.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 31.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 35.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 35.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 35.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 35.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIGH FREQ VENT INITIAL", "code_information": [{"code": "94002", "type": "CPT"}, {"code": "5506105", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 86.29, "maximum": 794.29, "gross_charge": 1785.0, "discounted_cash": 1338.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 714.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 694.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIGH FREQ VENT SUBSQ/DLY", "code_information": [{"code": "94003", "type": "CPT"}, {"code": "5506106", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 63.3, "maximum": 794.29, "gross_charge": 1785.0, "discounted_cash": 1338.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 714.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 694.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIGH INTEN BEH COUNS STD 30M", "code_information": [{"code": "G0445", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIGH RISK OBSTETRICS", "code_information": [{"code": "1990098", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 5615.0, "discounted_cash": 4211.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HIGH RISK OBSTETRICS", "code_information": [{"code": "2500098", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 5615.0, "discounted_cash": 4211.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HIGH RISK OBSTETRICS", "code_information": [{"code": "2510098", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 5615.0, "discounted_cash": 4211.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HIGH RISK RECURRENCE PRO CA", "code_information": [{"code": "G8465", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC", "code_information": [{"code": "481", "type": "MS-DRG"}], "standard_charges": [{"minimum": 69541.59, "maximum": 87631.79, "estimated_discounted_cash": 122569.94, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 69541.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 87631.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [{"code": "480", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11319.82, "maximum": 121847.72, "estimated_discounted_cash": 170101.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 68997.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 28169.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24509.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42009.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29641.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25790.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 72601.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 44203.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 31300.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 76664.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 46677.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27233.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 46677.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27233.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 31300.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 76664.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27233.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 46677.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 31300.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 76664.54, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 64452.68, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 12582.65, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 30381.01, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11319.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 96694.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 121847.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC", "code_information": [{"code": "482", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6679.44, "maximum": 68239.41, "estimated_discounted_cash": 104735.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 49944.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30013.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13493.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16502.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14198.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17364.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 52553.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31580.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14993.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 55494.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33348.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18335.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 55494.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33348.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18335.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14993.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33348.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14993.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 55494.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18335.84, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 42231.8, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 15930.2, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8285.37, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6679.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 54152.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 68239.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHR0 W/DEBRIDEMENT", "code_information": [{"code": "29862", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 33065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHR0 W/SYNOVECTOMY", "code_information": [{"code": "29863", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO ACETABULOPLASTY", "code_information": [{"code": "29915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 58379.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/FB REMOVAL", "code_information": [{"code": "29861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 33065.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/FEMOROPLASTY", "code_information": [{"code": "29914", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 33447.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/LABRAL REPAIR", "code_information": [{"code": "29916", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 30789.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHROGRAPHY", "code_information": [{"code": "73525", "type": "CPT"}, {"code": "4903525", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 766.08, "gross_charge": 3648.0, "discounted_cash": 2736.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 766.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 262.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 117.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 117.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 117.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 117.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 117.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP ARTHROGRAPHY", "code_information": [{"code": "73525", "type": "CPT"}, {"code": "4913525", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 766.08, "gross_charge": 3648.0, "discounted_cash": 2736.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 766.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 262.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 117.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 117.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 117.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 117.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 117.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP ARTHROSCOPY DX", "code_information": [{"code": "29860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP BI W/PEL 2WS", "code_information": [{"code": "73521", "type": "CPT"}, {"code": "4903520", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 278.88, "gross_charge": 1328.0, "discounted_cash": 996.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 278.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 142.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP BI W/PEL 2WS", "code_information": [{"code": "73521", "type": "CPT"}, {"code": "5013520", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 278.88, "gross_charge": 1328.0, "discounted_cash": 996.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 278.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 142.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP BI W/PEL 3-4 VWS", "code_information": [{"code": "73522", "type": "CPT"}, {"code": "4903522", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 176.75, "gross_charge": 1294.0, "discounted_cash": 970.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 176.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP BI W/PEL 3-4 VWS", "code_information": [{"code": "73522", "type": "CPT"}, {"code": "5013522", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 176.75, "gross_charge": 1294.0, "discounted_cash": 970.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 176.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee 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"standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIPPOTHERAPY PER SESSION", "code_information": [{"code": "S8940", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 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CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIST TYPE DOC ON REPORT", "code_information": [{"code": "G9283", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HISTAMINE/2", "code_information": [{"code": "83088", "type": "CPT"}, {"code": "7253088", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 150.6, "gross_charge": 462.0, "discounted_cash": 346.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 150.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.26, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTAMINE/3", "code_information": [{"code": "83088", "type": "CPT"}, {"code": "7253092", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 150.6, "gross_charge": 363.0, "discounted_cash": 272.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 150.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.26, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOCHEM STN W/FRZ SECT", "code_information": [{"code": "88314", "type": "CPT"}, {"code": "4303502", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 260.06, "gross_charge": 2589.0, "discounted_cash": 1941.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 260.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 109.08, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 109.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 109.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 109.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 109.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 79.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 79.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMA IA", "code_information": [{"code": "87385", "type": "CPT"}, {"code": "7257386", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 237.0, "discounted_cash": 177.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMA IA/3", "code_information": [{"code": "87385", "type": "CPT"}, {"code": "7253507", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 359.0, "discounted_cash": 269.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMOSIS AB", "code_information": [{"code": "86698", "type": "CPT"}, {"code": "7256176", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.73, "gross_charge": 223.0, "discounted_cash": 167.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMOSIS SKIN TEST", "code_information": [{"code": "86510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOTRIPSY MAL HEPATCEL TIS", "code_information": [{"code": "686T", "type": "CPT"}], "standard_charges": [{"minimum": 9008.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12500.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12500.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTRELIN ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1675", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.41, "maximum": 1.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ALPHA-1-PROTEINAS DIEM", "code_information": [{"code": "S9346", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTI-HEMOPHIL DIEM", "code_information": [{"code": "S9345", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTI-SPASMOTIC DIEM", "code_information": [{"code": "S9363", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTI-TNF PER DIEM", "code_information": [{"code": "S9359", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q12H DIEM", "code_information": [{"code": "S9501", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q24H DIEM", "code_information": [{"code": "S9500", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q3H DIEM", "code_information": [{"code": "S9497", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q4H DIEM", "code_information": [{"code": "S9504", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q6H DIEM", "code_information": [{"code": "S9503", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q8H DIEM", "code_information": [{"code": "S9502", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC TOTAL DIEM", "code_information": [{"code": "S9494", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT BLOOD PRODUCTS DIEM", "code_information": [{"code": "S9538", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CATH CARE NOC", "code_information": [{"code": "S5497", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CATH REPAIR KIT", "code_information": [{"code": "S5518", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CHELATION DIEM", "code_information": [{"code": "S9355", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CHEMO PER DIEM", "code_information": [{"code": "S9329", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT COMPLEX CATH CARE", "code_information": [{"code": "S5501", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CONT ANTICOAG DIEM", "code_information": [{"code": "S9336", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CONT ANTIEMETIC DIEM", "code_information": [{"code": "S9351", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CONT CHEM DIEM", "code_information": [{"code": "S9330", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CONT INSULIN DIEM", "code_information": [{"code": "S9353", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CONT PAIN PER DIEM", "code_information": [{"code": "S9326", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT CORTICOSTEROID/DIEM", "code_information": [{"code": "S9490", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT DECLOTTING KIT", "code_information": [{"code": "S5517", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT DEVICE REPAIR", "code_information": [{"code": "S5036", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT DIURETIC INFUS DIEM", "code_information": [{"code": "S9361", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL BOLUS NURS", "code_information": [{"code": "S9343", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL GRAV DIEM", "code_information": [{"code": "S9341", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL PER DIEM", "code_information": [{"code": "S9340", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL PUMP DIEM", "code_information": [{"code": "S9342", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ENZYME REPLACE DIEM", "code_information": [{"code": "S9357", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT HIGH RISK/ESCORT", "code_information": [{"code": "S9381", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA 1 LITER DIEM", "code_information": [{"code": "S9374", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA 2 LITER DIEM", "code_information": [{"code": "S9375", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA 3 LITER DIEM", "code_information": [{"code": "S9376", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA OVER 3L DIEM", "code_information": [{"code": "S9377", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA TOTAL DIEM", "code_information": [{"code": "S9373", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT IMMUNOTHERAPY DIEM", "code_information": [{"code": "S9338", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT INJ INTERFERON DIEM", "code_information": [{"code": "S9559", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT INT PAIN PER DIEM", "code_information": [{"code": "S9327", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT INTERIM CATH CARE", "code_information": [{"code": "S5502", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT INTERMIT CHEMO DIEM", "code_information": [{"code": "S9331", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT LONGTERM INFUSION DIEM", "code_information": [{"code": "S9347", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT MIDLINE CATH INSERT KIT", "code_information": [{"code": "S5521", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT NOC PER DIEM", "code_information": [{"code": "S9379", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT PAIN IMP PUMP DIEM", "code_information": [{"code": "S9328", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT PAIN MGMT PER DIEM", "code_information": [{"code": "S9325", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT PERITON DIALYSIS DIEM", "code_information": [{"code": "S9339", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT PICC INSERT KIT", "code_information": [{"code": "S5520", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT PICC INSERT NO SUPP", "code_information": [{"code": "S5522", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ROUTINE DEVICE MAINT", "code_information": [{"code": "S5035", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT SIMPLE CATH CARE", "code_information": [{"code": "S5498", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT SYMPATHOMIM DIEM", "code_information": [{"code": "S9348", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT TOCOLYSIS DIEM", "code_information": [{"code": "S9349", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT TPN 1 LITER DIEM", "code_information": [{"code": "S9365", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT TPN 2 LITER DIEM", "code_information": [{"code": "S9366", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT TPN 3 LITER DIEM", "code_information": [{"code": "S9367", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT TPN OVER 3L DIEM", "code_information": [{"code": "S9368", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT TPN TOTAL DIEM", "code_information": [{"code": 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CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 117.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 117.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 117.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HM GEST DM PER DIEM", "code_information": [{"code": "S9214", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HM POSTPAR HYPER PER DIEM", "code_information": [{"code": "S9212", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HM PREECLAMP PER DIEM", "code_information": [{"code": "S9213", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HMATRIX", "code_information": [{"code": "Q4134", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HMOGLBN FETAL(KLEIHAUER)", "code_information": [{"code": "85460", "type": "CPT"}, {"code": "4105460", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 39.46, "gross_charge": 167.0, "discounted_cash": 125.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HMOGLBN FETAL(KLEIHAUER)", "code_information": [{"code": "85460", "type": "CPT"}, {"code": "7255460", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 39.46, "gross_charge": 167.0, "discounted_cash": 125.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOCM 150-199MG/ML IODINE,1ML", "code_information": [{"code": "Q9959", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOCM 200-249MG/ML IODINE,1ML", "code_information": [{"code": "Q9960", 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOCM 350-399MG/ML ID 1ML", "code_information": [{"code": "Q9963", "type": "HCPCS"}, {"code": "5356186", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"minimum": 0.21, "maximum": 0.21, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 0.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOCM 350-399MG/ML ID 1ML", "code_information": [{"code": "Q9963", "type": "HCPCS"}, {"code": "5356186", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.21, "maximum": 0.21, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 0.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOCM < = 149MG/ML ID 1ML", "code_information": [{"code": "Q9958", "type": "HCPCS"}, {"code": "5356181", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.05, "gross_charge": 0.25, "discounted_cash": 0.19, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOCM < = 149MG/ML ID 1ML", "code_information": [{"code": "Q9958", "type": "HCPCS"}, {"code": "5356181", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.05, "gross_charge": 0.25, "discounted_cash": 0.19, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOCM>= 400MG/ML IODINE, 1ML", "code_information": [{"code": "Q9964", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOMAKER SERVICE NOS PER 15M", "code_information": [{"code": "S5130", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME ENVIRONMENT ASSESSMENT", "code_information": [{"code": "T1028", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME EPISODIC CASE 30 DAYS", "code_information": [{"code": "S0272", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME H PHYSIO DATA COLLEC TR", "code_information": [{"code": "G0322", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH AIDE OR CERTIFIE", "code_information": [{"code": "S9122", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "99374", "type": "CPT"}], "standard_charges": [{"minimum": 67.59, "maximum": 67.59, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "99375", "type": "CPT"}], "standard_charges": [{"minimum": 114.1, "maximum": 114.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "G0181", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME HOSPICE CASE 30 DAYS", "code_information": [{"code": "S0271", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME MGMT GEST HYPERTENSION", "code_information": [{"code": "S9211", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME MGMT PPROM", "code_information": [{"code": "S9209", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME MGMT PRETERM LABOR", "code_information": [{"code": "S9208", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME MODIFICATIONS PER SERV", "code_information": [{"code": "S5165", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding 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"standard_charge_dollar": 287.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 383.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 301.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 335.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 335.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 335.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 335.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME SLEEP TEST TYPE 3 UNATTD", "code_information": [{"code": "G0399", "type": "HCPCS"}, {"code": "4800399", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 301.5, "maximum": 1009.4, "gross_charge": 3605.0, "discounted_cash": 2703.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 757.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1009.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 301.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 335.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 335.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 335.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 335.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME SLEEP TEST TYPE 3 UNATTD", "code_information": [{"code": "G0399", "type": "HCPCS"}, {"code": "6910399", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 301.5, "maximum": 695.24, "gross_charge": 2483.0, "discounted_cash": 1862.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 521.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 695.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH 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"standard_charge_dollar": 23.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOMOCYSTEINE QUANT/2", "code_information": [{"code": "83090", "type": "CPT"}, {"code": "7253089", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 86.03, "gross_charge": 335.0, "discounted_cash": 251.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": 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"standard_charge_dollar": 40.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 39.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 44.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 44.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 44.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOPD MNTL HLT, 30-60 MIN", "code_information": [{"code": "C7901", "type": "HCPCS"}], "standard_charges": [{"minimum": 100.35, "maximum": 114.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 103.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 100.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 114.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 114.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 114.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOPD MNTL HLT, GRP", "code_information": [{"code": "C7903", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.12, "maximum": 40.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 35.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 40.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP IP/OBS DSCHRG MGMT 30/<", "code_information": [{"code": "99238", "type": "CPT"}], "standard_charges": [{"minimum": 69.14, "maximum": 69.14, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 69.14, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 69.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 69.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 69.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 69.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP IP/OBS DSCHRG MGMT >30", "code_information": [{"code": "99239", "type": "CPT"}], "standard_charges": [{"minimum": 99.19, "maximum": 99.19, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 99.19, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 99.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 99.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 99.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 99.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP IP/OBS SAME DATE HI 85", "code_information": [{"code": "99236", "type": "CPT"}], "standard_charges": [{"minimum": 211.9, "maximum": 211.9, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 211.9, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 211.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 211.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 211.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 211.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSP IP/OBS SAME DATE MOD 70", "code_information": [{"code": "99235", "type": "CPT"}], "standard_charges": [{"minimum": 170.47, "maximum": 170.47, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 170.47, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 170.47, "methodology": "fee 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"GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 129.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 129.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 129.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE SUPERVISION", "code_information": [{"code": "99377", "type": "CPT"}], "standard_charges": [{"minimum": 67.59, "maximum": 67.59, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE SUPERVISION", "code_information": [{"code": "99378", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 123.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE SUPERVISION", "code_information": [{"code": "G0182", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE, IN THE HOME, P", "code_information": [{"code": "S9126", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE EVALUATION PREELECTI", "code_information": [{"code": "G0337", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE HOME CARE IN HOSPICE", "code_information": [{"code": "Q5010", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE IN HOSPICE FACILITY", "code_information": [{"code": "Q5006", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE IN INPATIENT PSYCH", "code_information": [{"code": "Q5008", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE IN LT/NON-SKILLED NF", "code_information": [{"code": "Q5003", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE IN LTCH", "code_information": [{"code": "Q5007", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE IN SNF", "code_information": [{"code": "Q5004", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE OR HOME HLTH IN HOME", "code_information": [{"code": "Q5001", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE REFER VISIT NONMD", "code_information": [{"code": "S0255", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE, INPATIENT HOSPITAL", "code_information": [{"code": "Q5005", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE/HOME HLTH IN ASST LV", "code_information": [{"code": "Q5002", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPICE/HOME HLTH, PLACE NOS", "code_information": [{"code": "Q5009", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPITAL OUTPT CLINIC VISIT", "code_information": [{"code": "G0463", "type": "HCPCS"}], "standard_charges": [{"estimated_discounted_cash": 658.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOSPITALIST VISIT", "code_information": [{"code": "S0310", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HPA-1 GENOTYPING", "code_information": [{"code": "81105", "type": "CPT"}], "standard_charges": [{"minimum": 122.22, "maximum": 122.22, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-15 GENOTYPING", "code_information": [{"code": "81112", "type": "CPT"}], "standard_charges": [{"minimum": 122.22, "maximum": 122.22, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-4 GENOTYPING", "code_information": [{"code": "81108", "type": "CPT"}], "standard_charges": [{"minimum": 122.22, "maximum": 122.22, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-5 GENOTYPING", "code_information": [{"code": "81109", "type": "CPT"}], "standard_charges": [{"minimum": 122.22, "maximum": 122.22, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-6 GENOTYPING", "code_information": [{"code": "81110", "type": "CPT"}], "standard_charges": [{"minimum": 122.22, "maximum": 122.22, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-9 GENOTYPING", "code_information": [{"code": "81111", "type": "CPT"}], "standard_charges": [{"minimum": 122.22, "maximum": 122.22, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV 16 18 45", "code_information": [{"code": "87625", "type": "CPT"}, {"code": "7257655", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 152.17, "gross_charge": 233.0, "discounted_cash": 174.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 152.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 40.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV COMBO ASSAY CA SCREEN", "code_information": [{"code": "G0476", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.09, "maximum": 35.09, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV HI RISK TYPES MALE URINE", "code_information": [{"code": "96U", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 35.09, "setting": 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{"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315332", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROXYZINE 10/5 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315332", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROXYZINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305830", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROXYZINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305830", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROXYZINE 10MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315325", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROXYZINE 10MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315325", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROXYZINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305835", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROXYZINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305835", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROXYZINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305836", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROXYZINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305836", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HYDROXYZINE PAMOATE 25MG", "code_information": [{"code": "Q0177", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYDRXINDOL ACD5(HIAA)QT", "code_information": [{"code": "83497", "type": "CPT"}, {"code": "7253497", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.74, "gross_charge": 146.0, "discounted_cash": 109.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.01, "methodology": "fee 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"standard_charge_dollar": 37.95, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDRXYPRGSTRONE 17-D/2", "code_information": 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"standard_charge_dollar": 37.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYMENOTOMY", "code_information": [{"code": "56442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYMOVIS INJECTION 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7322", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.86, "maximum": 17.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYOID MYOTOMY & SUSPENSION", "code_information": [{"code": "21685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYOSCYAM.125/ML 15MLDRLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315334", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HYOSCYAM.125/ML 15MLDRLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315334", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HYOSCYAMINE .125MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305865", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HYOSCYAMINE .125MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305865", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HYOSCYAMINE .375MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305893", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HYOSCYAMINE .375MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305893", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HYPERBARIC OXYGEN THERAPY", "code_information": [{"code": "99183", "type": "CPT"}], "standard_charges": [{"minimum": 216.68, "maximum": 247.79, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 219.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 223.05, "methodology": "fee 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"fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 219.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITH MCC", "code_information": [{"code": "304", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32133.06, "maximum": 145430.89, "estimated_discounted_cash": 78639.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 88453.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52787.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 62709.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE 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"plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39510.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49788.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITHOUT MCC", "code_information": [{"code": "305", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13438.46, "maximum": 82108.7, "estimated_discounted_cash": 51200.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 73897.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26282.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19710.24, "methodology": "case 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"methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21900.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 44230.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 82108.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29202.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21900.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 44230.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 82108.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29202.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21900.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 44230.28, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 25013.98, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13438.46, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16167.64, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 50986.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25070.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31592.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 598.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 598.35, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 378.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 350.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 378.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 378.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 378.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 378.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1220.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 933.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 616.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1099.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1220.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1220.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1220.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1220.92, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 616.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 616.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 616.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 616.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 900.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 825.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 555.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 810.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 555.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 555.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 555.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 555.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1200.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1200.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 786.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 810.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 786.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 786.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 786.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 786.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 900.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 592.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 810.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPNOTHERAPY", "code_information": [{"code": "90880", "type": "CPT"}], "standard_charges": [{"minimum": 89.07, "maximum": 118.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 104.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 118.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 118.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 118.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPOTHERMIA ILL NEONATE", "code_information": [{"code": "99184", "type": "CPT"}], "standard_charges": [{"minimum": 439.11, "maximum": 502.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 452.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 439.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 502.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 502.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 502.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPOXIA RESPONSE CURVE", "code_information": [{"code": "94450", "type": "CPT"}], "standard_charges": [{"minimum": 57.2, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPRPHENYLALNINMIA MNTR QUAN", "code_information": [{"code": "382U", "type": "CPT"}], "standard_charges": [{"minimum": 51.64, "maximum": 51.64, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 51.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 51.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYQVIA 100MG IMMUNEGLOBULIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1575", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.34, "maximum": 18.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/BLADDER REPAIR", "code_information": [{"code": "51925", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1137.29, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1137.29, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1137.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1137.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1137.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/REVISE VAGINA", "code_information": [{"code": "58275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 965.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 965.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 965.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 965.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 965.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/REVISE VAGINA", "code_information": [{"code": "58280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1033.27, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1033.27, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1033.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1033.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1033.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSALPINGOGRAPHY", "code_information": [{"code": "74740", "type": "CPT"}, {"code": "4904740", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 945.63, "gross_charge": 4503.0, "discounted_cash": 3377.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 945.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 180.63, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY ABLATION", "code_information": [{"code": "58563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 16304.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6586.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY BIOPSY", "code_information": [{"code": "58558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14800.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY DX SEP PROC", "code_information": [{"code": "58555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12422.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY LYSIS", "code_information": [{"code": "58559", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY REMOVE FB", "code_information": [{"code": "58562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 967.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY REMOVE MYOMA", "code_information": [{"code": "58561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 24845.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY RESECT SEPTUM", "code_information": [{"code": "58560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1528.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY STERILIZATION", "code_information": [{"code": "58565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSONOGRAPHY", "code_information": [{"code": "76831", "type": "CPT"}, {"code": "5016831", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 564.69, "gross_charge": 2689.0, "discounted_cash": 2016.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 564.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 233.32, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 132.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 132.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 132.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 132.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 132.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSONOGRAPHY", "code_information": [{"code": "76831", "type": "CPT"}, {"code": "5066831", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 564.69, "gross_charge": 2689.0, "discounted_cash": 2016.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 564.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 233.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 132.04, "methodology": 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"setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Human papillomavirus (HPV), E6/E7 markers for high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68), cervical cells, branched-chain capture hybridization, reported as negative or positive for high risk for HPV", "code_information": [{"code": "502U", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 35.09, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hyperbaric oxygen", "code_information": [{"code": "C1300", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Hyperten mg qual act perform", "code_information": [{"code": "G8763", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Hypertension mg", "code_information": [{"code": "G8904", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I & D OF VULVA/PERINEUM", "code_information": [{"code": "56405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3140.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I & D VAG HEMATOMA NON-OB", "code_information": [{"code": "57023", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I & D VAGINAL HEMATOMA PP", "code_information": [{"code": "57022", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I 123 MIBG DOSE", "code_information": [{"code": "A9582", "type": "HCPCS"}, {"code": "5192180", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 5241.23, "maximum": 5823.59, "gross_charge": 18636.0, "discounted_cash": 13977.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5241.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5823.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5823.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5823.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5823.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I 125 STRND PER SOURCE", "code_information": [{"code": "C2638", "type": "HCPCS"}, {"code": "5190015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 46.2, "maximum": 63.07, "gross_charge": 220.0, "discounted_cash": 165.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 56.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 63.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 63.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 63.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 63.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D ABSC INTRAORAL SOFT TISS", "code_information": [{"code": "D7510", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS COMP/MULTIPLE", "code_information": [{"code": "10061", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 20574.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS EXTRAORAL", "code_information": [{"code": "D7520", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS P-SPINE L/S/LS", "code_information": [{"code": "22015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 872.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 872.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 872.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 872.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 872.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS SIMP/SNGL", "code_information": [{"code": "6900051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D ABSCESS SIMP/SNGL", "code_information": [{"code": "6900051", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D ABSCESS SIMPLE/SINGLE", "code_information": [{"code": "10060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2934.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_percentage": 36.9, "possible_amount": 115.63, "count": "1 through 10", "median_amount": 115.63, "methodology": "percent of total billed charges", "10th_percentile": 115.63, "90th_percentile": 115.63}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D COMPLEX DRAIN WOUND", "code_information": [{"code": "6900133", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8584.0, "discounted_cash": 6438.0, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D COMPLEX DRAIN WOUND", "code_information": [{"code": "6900133", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 8584.0, "discounted_cash": 6438.0, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D COMPLEX PO WOUND INFCTJ", "code_information": [{"code": "10180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 23828.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D HEMA SEROMA FL", "code_information": [{"code": "5060010", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10188.0, "discounted_cash": 7641.0, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D HEMA SEROMA FL", "code_information": [{"code": "6909896", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5096.0, "discounted_cash": 3822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D HEMA SEROMA FL", "code_information": [{"code": "6909896", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 5096.0, "discounted_cash": 3822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D HMTMA SEROMA/FLUID COLLJ", "code_information": [{"code": "10140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4815.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D P-SPINE C/T/CERV-THOR", "code_information": [{"code": "22010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 878.1, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 878.1, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 878.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 878.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 878.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D PILONIDAL CYST COMP", "code_information": [{"code": "10081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 138.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D PILONIDAL CYST SIMPLE", "code_information": [{"code": "10080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6085.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D SKIN ABSCESS COMPLEX", "code_information": [{"code": "6900052", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D SKIN ABSCESS COMPLEX", "code_information": [{"code": "6900052", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D UPR A/E BURSA", "code_information": [{"code": "23931", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D UPR A/E DP ABSC/HMTMA", "code_information": [{"code": "23930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I131 IODIDE SOL, RX", "code_information": [{"code": "A9530", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.78, "maximum": 18.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I131 SERUM ALBUMIN, DX", "code_information": [{"code": "A9524", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IA INFECT AGENT AB QN NOS/2", "code_information": [{"code": "86317", "type": "CPT"}, {"code": "7256313", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.47, "gross_charge": 233.0, "discounted_cash": 174.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.47, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IA INFECT AGENT AB QN NOS/5", "code_information": [{"code": "86317", "type": "CPT"}, {"code": "7256317", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.47, "gross_charge": 86.0, "discounted_cash": 64.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.47, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IA INFECT AGENT AB QN NOS/7", "code_information": [{"code": "86317", "type": "CPT"}, {"code": "7256320", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.47, "gross_charge": 86.0, "discounted_cash": 64.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.47, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IA INFECT AGENT AB QN NOS/9", "code_information": [{"code": "86317", "type": "CPT"}, {"code": "7256617", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.47, "gross_charge": 86.0, "discounted_cash": 64.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.95, 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NONOPTIONS", "standard_charge_dollar": 2126.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2126.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN 20BCT&FNG ORG", "code_information": [{"code": "321U", "type": "CPT"}], "standard_charges": [{"minimum": 634.84, "maximum": 634.84, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 634.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 634.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN SEMIQ DNA16&1", "code_information": [{"code": "371U", "type": "CPT"}], "standard_charges": [{"minimum": 416.78, "maximum": 416.78, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA VAG PTHGN PANEL 27 ORG", "code_information": [{"code": "330U", "type": "CPT"}], "standard_charges": [{"minimum": 416.78, "maximum": 416.78, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA-DNA/RNA PROBE TQ 6-11", "code_information": [{"code": "87506", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1039.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1039.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBMFS SEQ ALYS PNL 30 GENES", "code_information": [{"code": "81441", "type": "CPT"}], "standard_charges": [{"minimum": 2448.56, "maximum": 2448.56, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2448.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2448.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUPROFEN 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305915", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IBUPROFEN 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305915", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IBUPROFEN 600MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305919", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IBUPROFEN 600MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305919", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IBUPROFEN 800MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305920", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IBUPROFEN 800MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305920", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IBUTILIDE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1742", "type": "HCPCS"}, {"code": "5321314", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 312.44, "maximum": 347.15, "gross_charge": 850.0, "discounted_cash": 637.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 312.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 347.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 347.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 347.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 347.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUTILIDE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1742", "type": "HCPCS"}, {"code": "5321314", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 312.44, "maximum": 347.15, "gross_charge": 850.0, "discounted_cash": 637.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 312.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 347.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 347.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 347.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 347.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IC INF PBW 2501-5000 G SUBSQ", "code_information": [{"code": "99480", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IC LBW INF 1500-2500 G SUBSQ", "code_information": [{"code": "99479", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IC LBW INF < 1500 GM SUBSQ", "code_information": [{"code": "99478", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ICATIBANT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1744", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.75, "maximum": 79.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 79.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 79.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 79.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 79.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICG ANGIOGRAPHY I&R UNI/BI", "code_information": [{"code": "92240", "type": "CPT"}], "standard_charges": [{"minimum": 281.9, "maximum": 392.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 281.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 281.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 281.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 281.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 281.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TEST DRUG/BUG", "code_information": [{"code": "95024", "type": "CPT"}], "standard_charges": [{"minimum": 8.01, "maximum": 57.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TEST-DELAYED", "code_information": [{"code": "95028", "type": "CPT"}], "standard_charges": [{"minimum": 12.73, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TITRATE-AIRBORN", "code_information": [{"code": "95027", "type": "CPT"}], "standard_charges": [{"minimum": 6.16, "maximum": 57.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ID ASPERGILLUS DNA 4 SPECIES", "code_information": [{"code": "109U", "type": "CPT"}], "standard_charges": [{"minimum": 142.63, "maximum": 142.63, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ID CA IMMNTX EACH ADDL NJX", "code_information": [{"code": "709T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ID CA IMMNTX PREP & 1ST NJX", "code_information": [{"code": "708T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IDENTIFY SPERM TISSUE", "code_information": [{"code": "89264", "type": "CPT"}], "standard_charges": [{"minimum": 49.76, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDET 1 OR MORE LEVELS", "code_information": [{"code": "22527", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IDET SINGLE LEVEL", "code_information": [{"code": "22526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IDH1 (isocitrate dehydrogenase 1 [NADP+]), IDH2 (isocitrate dehydrogenase 2 [NADP+]), and TERT (telomerase reverse transcriptase) promoter (eg, central nervous system [CNS] tumors), next-generation sequencing (single-nucleotide variants [SNV], deletions, ", "code_information": [{"code": "481U", "type": "CPT"}], "standard_charges": [{"minimum": 674.24, "maximum": 674.24, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 674.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 674.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDH1 COMMON VARIANTS", "code_information": [{"code": "81120", "type": "CPT"}], "standard_charges": [{"minimum": 193.25, "maximum": 193.25, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 193.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 193.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDH2 COMMON VARIANTS", "code_information": [{"code": "81121", "type": "CPT"}], "standard_charges": [{"minimum": 295.79, "maximum": 295.79, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 295.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 295.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDURSULFASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1743", "type": "HCPCS"}], "standard_charges": [{"minimum": 502.61, "maximum": 558.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 502.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 558.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 558.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 558.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 558.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFNL3 GENE ANALYSIS", "code_information": [{"code": "81283", "type": "CPT"}, {"code": "4100349", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 73.37, "maximum": 73.37, "gross_charge": 275.0, "discounted_cash": 206.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 73.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 73.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFR CORO W/WO PHARM STRESS", "code_information": [{"code": "93799", "type": "CPT"}, {"code": "4610014", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 174.0, "discounted_cash": 130.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IG PARAPROTEIN QUAL BLD/UR", "code_information": [{"code": "77U", "type": "CPT"}], "standard_charges": [{"minimum": 43.43, "maximum": 43.43, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 43.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IG-E SERUM", "code_information": [{"code": "82785", "type": "CPT"}, {"code": "4103513", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.99, "gross_charge": 275.0, "discounted_cash": 206.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IG-E SERUM/3", "code_information": [{"code": "82785", "type": "CPT"}, {"code": "7253513", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.99, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.99, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH GENE ANLS AMP METHOD", "code_information": [{"code": "81261", "type": "CPT"}, {"code": "7251262", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1011.12, "gross_charge": 927.0, "discounted_cash": 695.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1011.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 197.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 197.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH GENE REARRANG DIR PROBE", "code_information": [{"code": "81262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 222.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 222.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 68.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 68.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH VARIABLE MUTATION", "code_information": [{"code": "81263", "type": "CPT"}, {"code": "7251264", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1504.09, "gross_charge": 4145.0, "discounted_cash": 3108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1504.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 294.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 294.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH@/BCL2 TRANSLOCATION ALYS", "code_information": [{"code": "81278", "type": "CPT"}], "standard_charges": [{"minimum": 207.31, "maximum": 207.31, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGK REARRANGEABN CLONAL POP", "code_information": [{"code": "81264", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 762.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 762.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 172.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 172.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV ADJUVANT VACCINE IM", "code_information": [{"code": "90653", "type": "CPT"}], "standard_charges": [{"minimum": 88.34, "maximum": 98.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 88.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV NO PRSV INCREASED AG IM", "code_information": [{"code": "90662", "type": "CPT"}], "standard_charges": [{"minimum": 88.34, "maximum": 98.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 88.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACC NO PRSV 0.25 ML IM", "code_information": [{"code": "90655", "type": "CPT"}], "standard_charges": [{"minimum": 15.52, "maximum": 17.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACCINE SPLT 0.25 ML IM", "code_information": [{"code": "90657", "type": "CPT"}], "standard_charges": [{"minimum": 9.93, "maximum": 11.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACCINE SPLT 0.5 ML IM", "code_information": [{"code": "90658", "type": "CPT"}], "standard_charges": [{"minimum": 19.86, "maximum": 22.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 22.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 22.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 22.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACC NO PRSV 0.25 ML IM", "code_information": [{"code": "90685", "type": "CPT"}], "standard_charges": [{"minimum": 19.48, "maximum": 21.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACCINE SPLT 0.25 ML IM", "code_information": [{"code": "90687", "type": "CPT"}], "standard_charges": [{"minimum": 9.89, "maximum": 10.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACCINE SPLT 0.5 ML IM", "code_information": [{"code": "90688", "type": "CPT"}], "standard_charges": [{"minimum": 19.78, "maximum": 21.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IKBKAP COMMON VARIANTS", "code_information": [{"code": "81260", "type": "CPT"}, {"code": "7251261", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 39.31, "maximum": 39.31, "gross_charge": 862.0, "discounted_cash": 646.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILEOSTOMY/JEJUNOSTOMY", "code_information": [{"code": "44310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 958.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 958.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 958.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 958.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 958.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC ART BI W CARD CTH", "code_information": [{"code": "G0278", "type": "HCPCS"}, {"code": "4610278", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "gross_charge": 2708.0, "discounted_cash": 2031.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 568.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC BONE GRAFT MICROVASC", "code_information": [{"code": "20956", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC", "code_information": [{"code": "37220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC ADD-ON", "code_information": [{"code": "37222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT", "code_information": [{"code": "37221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT ADD-ON", "code_information": [{"code": "37223", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILOPROST NON-COMP UNIT DOSE", "code_information": [{"code": "Q4074", "type": "HCPCS"}], "standard_charges": [{"minimum": 143.03, "maximum": 158.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 143.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 158.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 158.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 158.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 158.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM ADMIN 1ST/ONLY COMPONENT", "code_information": [{"code": "90460", "type": "CPT"}], "standard_charges": [{"minimum": 34.25, "maximum": 39.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM ADMIN EACH ADDL COMPONENT", "code_information": [{"code": "90461", "type": "CPT"}], "standard_charges": [{"minimum": 26.04, "maximum": 29.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER CMPL", "code_information": [{"code": "263T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER HRVST ONL", "code_information": [{"code": "265T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER XCL HRVST", "code_information": [{"code": "264T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID COLXN VISC", "code_information": [{"code": "49405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID PERI/RETRO", "code_information": [{"code": "49406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID TRNS/VGNL", "code_information": [{"code": "49407", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMAGE NOT STD NOMENCLATURE", "code_information": [{"code": "G9319", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMAGE STD NOMENCLATURE", "code_information": [{"code": "G9318", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMAGING COIL, MR, INSERTABLE", "code_information": [{"code": "C1770", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMATINIB 100 MG", "code_information": [{"code": "S0088", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.04, "maximum": 3.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMATINIB 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305931", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2006.0, "discounted_cash": 1504.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMATINIB 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305931", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2006.0, "discounted_cash": 1504.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG CATH FLUID COL VISC", "code_information": [{"code": "4919415", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9255.0, "discounted_cash": 6941.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG CATH FLUID COL VISC", "code_information": [{"code": "5059405", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9255.0, "discounted_cash": 6941.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG CATH FLUID COL VISC", "code_information": [{"code": "5069405", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9255.0, "discounted_cash": 6941.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG CATH FLUID PERI/RETR", "code_information": [{"code": "4919406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9255.0, "discounted_cash": 6941.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG CATH FLUID PERI/RETR", "code_information": [{"code": "5059406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9255.0, "discounted_cash": 6941.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG CATH FLUID PERI/RETR", "code_information": [{"code": "5069406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9255.0, "discounted_cash": 6941.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG GID FLU COLL DRG SFT TIS", "code_information": [{"code": "10030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETC/MNTR DS PHY/QHP", "code_information": [{"code": "92228", "type": "CPT"}], "standard_charges": [{"minimum": 474.18, "maximum": 542.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 488.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 474.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 542.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 542.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 542.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETC/MNTR DS POC ALY", "code_information": [{"code": "92229", "type": "CPT"}], "standard_charges": [{"minimum": 75.35, "maximum": 86.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 77.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 75.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 86.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 86.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 86.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETCJ/MNTR DS STAFF", "code_information": [{"code": "92227", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMIPRAMINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305949", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMIPRAMINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305949", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMIPRAMINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305950", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMIPRAMINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305950", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMM ADM EA ADDL VACCINE", "code_information": [{"code": "90472", "type": "CPT"}, {"code": "3100472", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 11.4, "gross_charge": 215.0, "discounted_cash": 161.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMM ADM EA ADDL VACCINE", "code_information": [{"code": "90472", "type": "CPT"}, {"code": "4540472", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 11.4, "gross_charge": 185.0, "discounted_cash": 138.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMM ADM EA ADDL VACCINE", "code_information": [{"code": "90472", "type": "CPT"}, {"code": "6103998", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 11.4, "gross_charge": 215.0, "discounted_cash": 161.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMM ADM EA ADDL VACCINE", "code_information": [{"code": "90472", "type": "CPT"}, {"code": "6290472", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 11.4, "gross_charge": 182.0, "discounted_cash": 136.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMM ADM EA ADDL VACCINE", "code_information": [{"code": "90472", "type": "CPT"}, {"code": "6293998", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 11.4, "maximum": 11.4, "gross_charge": 215.0, "discounted_cash": 161.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee 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"facility"}]}, {"description": "IMP TISS DERMAMATRIX", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4023098", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3357.69, "maximum": 3357.69, "gross_charge": 15989.0, "discounted_cash": 11991.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3357.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMP TISS DERMAMATRIX", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4023098", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3357.69, "maximum": 3357.69, "gross_charge": 15989.0, "discounted_cash": 11991.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3357.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMP WEDGE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8152025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3139.29, "maximum": 3139.29, "gross_charge": 14949.0, "discounted_cash": 11211.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3139.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMP WEDGE EVANS CANC TIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3306.24, "maximum": 3306.24, "gross_charge": 15744.0, "discounted_cash": 11808.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3306.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REM BONY W/COMP", "code_information": [{"code": "D7241", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REMOV COMP BONY", "code_information": [{"code": "D7240", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REMOV PART BONY", "code_information": [{"code": "D7230", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL ABSRB MSH/PRSTH DLY CLS", "code_information": [{"code": "15778", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPL ANCHOR BIOSTATAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8151978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 587.37, "maximum": 587.37, "gross_charge": 2797.0, "discounted_cash": 2097.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 587.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL ANCHOR CRKSCRW 5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8151980", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 489.72, "maximum": 489.72, "gross_charge": 2332.0, "discounted_cash": 1749.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 489.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL MENISCAL ARROW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8204796", "type": "CDM"}], "standard_charges": [{"minimum": 120.96, "maximum": 120.96, "gross_charge": 576.0, "discounted_cash": 432.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 120.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SK TC ESP<100", "code_information": [{"code": "69716", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69729", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SKULL PERQ ESP", "code_information": [{"code": "69714", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPL SUTURE ANCHOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8152038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1432.41, "maximum": 1432.41, "gross_charge": 6821.0, "discounted_cash": 5115.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1432.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL/REDO ELECTRD ANTRUM", "code_information": [{"code": "43881", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT AUDITORY BRAIN IMP", "code_information": [{"code": "S2235", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1120.53, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1120.53, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1120.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1120.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1120.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61533", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1419.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1419.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1419.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1419.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1419.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1400.04, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1400.04, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1400.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1400.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1400.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT COCHLEAR DEVICE", "code_information": [{"code": "69930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25420.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25420.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25420.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25420.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25420.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25420.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT EYE DRUG SYSTEM", "code_information": [{"code": "67027", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT HORMONE PELLET(S)", "code_information": [{"code": "11980", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT MANDIBLE FOR AUGMENT", "code_information": [{"code": "D7996", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NERVE END", "code_information": [{"code": "64787", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRDE ADDL", "code_information": [{"code": "61864", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 407.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 407.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 407.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 407.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 407.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRDE ADDL", "code_information": [{"code": "61868", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 593.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 593.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 593.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 593.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 593.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODE", "code_information": [{"code": "61863", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1421.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1421.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1421.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1421.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1421.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODE", "code_information": [{"code": "61867", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2077.07, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2077.07, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2077.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2077.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2077.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "61850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 907.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 907.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 907.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 907.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 907.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "61860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1449.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1449.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1449.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1449.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1449.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "63650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "63655", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14145.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14145.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14145.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14145.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14145.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14145.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12416.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3714.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROSTIM ARRAYS", "code_information": [{"code": "61886", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SEMI-IMP HEAR", "code_information": [{"code": "S2230", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPACER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8284.5, "maximum": 8284.5, "gross_charge": 39450.0, "discounted_cash": 29587.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 8284.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINAL CANAL CATH", "code_information": [{"code": "62350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 31963.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINAL CANAL CATH", "code_information": [{"code": "62351", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFUSION PUMP", "code_information": [{"code": "62361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11790.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11790.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11790.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11790.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11790.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFUSION PUMP", "code_information": [{"code": "62362", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 53114.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11790.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11790.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11790.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11790.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11790.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT TCAT PULM VLV PERQ", "code_information": [{"code": "33477", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT URETER IN BOWEL", "code_information": [{"code": "50800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 949.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 949.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 949.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 949.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 949.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT VENTRICULAR DEVICE", "code_information": [{"code": "33975", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1097.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1097.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1097.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1097.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1097.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT VENTRICULAR DEVICE", "code_information": [{"code": "33976", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1232.26, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1232.26, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1232.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1232.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1232.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT/REPLACE HEARING AID", "code_information": [{"code": "69710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLNT,BON VOID FILLER-STRIP", "code_information": [{"code": "C9362", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT ANT SGM IO NBIO RX SYS", "code_information": [{"code": "660T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14311.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12878.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14311.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT BRAIN CHEMOTX ADD-ON", "code_information": [{"code": "61517", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 84.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 84.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 84.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 84.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 84.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT CRAN BONE FLAP TO ABDO", "code_information": [{"code": "61316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 83.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 83.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 83.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 83.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 83.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT NROSTM PLS GEN SNG REC", "code_information": [{"code": "L8685", "type": "HCPCS"}], "standard_charges": [{"minimum": 13457.92, "maximum": 15390.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13853.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13457.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15390.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15390.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15390.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV GEN", "code_information": [{"code": "268T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV LEAD", "code_information": [{"code": "267T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV TOTAL", "code_information": [{"code": "266T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLTJ NTRSTRML CRNL RNG SEG", "code_information": [{"code": "65785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLTJ SYNTH RNFCMT ABDL WAL", "code_information": [{"code": "437T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLTJ TOT RPLCMT HRT SYS", "code_information": [{"code": "33927", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPORTED LIPODOX INJ", "code_information": [{"code": "Q2049", "type": "HCPCS"}], "standard_charges": [{"minimum": 442.42, "maximum": 491.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 442.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 491.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 491.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 491.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 491.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPRESSION CASTING FT", "code_information": [{"code": "S0395", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPROVE VISUAL FUNCT", "code_information": [{"code": "G0913", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPRV CARE LE JNT REPR MVP", "code_information": [{"code": "G0058", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMRT COMPLEX", "code_information": [{"code": "77386", "type": "CPT"}, {"code": "5107386", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 900.64, "gross_charge": 6552.0, "discounted_cash": 4914.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 810.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMRT MLC CONST DESIGN", "code_information": [{"code": "77338", "type": "CPT"}, {"code": "5100022", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1826.33, "gross_charge": 2696.0, "discounted_cash": 2022.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 566.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1826.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 501.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMRT PLAN W DOSE VOLUME", "code_information": [{"code": "77301", "type": "CPT"}, {"code": "5107302", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 7000.95, "gross_charge": 11268.0, "discounted_cash": 8451.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2366.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7000.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2353.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1859.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2064.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2064.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2064.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2064.99, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2353.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2353.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2353.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2353.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMRT SIMPLE", "code_information": [{"code": "77385", "type": "CPT"}, {"code": "5107385", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 900.64, "gross_charge": 6552.0, "discounted_cash": 4914.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 810.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMUGLUCERASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1786", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.87, "maximum": 43.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 38.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 43.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 43.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 43.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN GNOTYP CD44 EXONS 2 3 6", "code_information": [{"code": "191U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN SITU EA PRB PER SPEC", "code_information": [{"code": "88365", "type": "CPT"}, {"code": "7270092", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 262.84, "gross_charge": 845.0, "discounted_cash": 633.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 262.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 168.13, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 168.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 168.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 168.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 168.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN-HOSPITAL ON CALL SERVICE", "code_information": [{"code": "99026", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN111 IBRITUMOMAB, DX", "code_information": [{"code": "A9542", "type": "HCPCS"}], "standard_charges": [{"minimum": 5398.47, "maximum": 5996.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5398.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5996.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5996.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5996.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5996.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN111 OXINE .5MCI", "code_information": [{"code": "A9547", "type": "HCPCS"}, {"code": "5191729", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 2758.04, "maximum": 3063.81, "gross_charge": 7863.0, "discounted_cash": 5897.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2758.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3063.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3063.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3063.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3063.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN111 PENTETATE", "code_information": [{"code": "A9548", "type": "HCPCS"}], "standard_charges": [{"minimum": 637.32, "maximum": 707.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 637.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 707.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 707.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 707.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 707.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INBORN AND OTHER DISORDERS OF METABOLISM", "code_information": [{"code": "642", "type": "MS-DRG"}], "standard_charges": [{"minimum": 47216.56, "maximum": 59499.24, "estimated_discounted_cash": 42509.24, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47216.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 59499.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INC DP OPN B1 CRTX HUM/ELBW", "code_information": [{"code": "23935", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INC&RMVL FB SUBQ TISS COMP", "code_information": [{"code": "10121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INC&RMVL FB SUBQ TISS SMPL", "code_information": [{"code": "10120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3772.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCAL BX SKN EA SEP/ADDL", "code_information": [{"code": "11107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCAL BX SKN SINGLE LES", "code_information": [{"code": "11106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1710.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG CERV", "code_information": [{"code": "22210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1711.64, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1711.64, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1711.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1711.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1711.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG LUMBAR", "code_information": [{"code": "22214", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1433.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1433.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1433.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1433.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1433.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG THORAC", "code_information": [{"code": "22212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1417.71, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1417.71, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1417.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1417.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1417.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCIS ADDL SPINE SEGMENT", "code_information": [{"code": "22216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 370.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 370.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 370.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 370.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 370.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN ADL SEG", "code_information": [{"code": "22208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 563.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 563.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 563.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 563.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 563.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN LUMBAR", "code_information": [{"code": "22207", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2238.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2238.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2238.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2238.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2238.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN THORAC", "code_information": [{"code": "22206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2266.12, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2266.12, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2266.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2266.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2266.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE & DRAIN BLADDER", "code_information": [{"code": "51040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18043.11, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE & TREAT BLADDER", "code_information": [{"code": "51020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE & TREAT BLADDER", "code_information": [{"code": "51030", "type": "CPT"}], "standard_charges": [{"minimum": 1107.15, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE BILE DUCT SPHINCTER", "code_information": [{"code": "47460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1165.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1165.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1165.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1165.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1165.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE BLADDER/DRAIN URETER", "code_information": [{"code": "51045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE DIAPHRAGM NERVE", "code_information": [{"code": "64746", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE EXTERNAL HEMORRHOID", "code_information": [{"code": "46083", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE FINGER TENDON SHEATH", "code_information": [{"code": "26055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 20526.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE FLEXOR CARPI RADIALIS", "code_information": [{"code": "25001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE HAND/FINGER TENDON", "code_information": [{"code": "26460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64763", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64766", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR", "code_information": [{"code": "69801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR NERVE", "code_information": [{"code": "69915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR NERVE", "code_information": [{"code": "69950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1828.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1828.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1828.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1828.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1828.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 133.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 133.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 133.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 133.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 133.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE STRANDS", "code_information": [{"code": "67030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE NERVE BACK OF HEAD", "code_information": [{"code": "64744", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL (PRESS RELIEF)", "code_information": [{"code": "61343", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2065.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2065.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2065.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2065.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2065.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61458", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1890.6, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1890.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1890.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1890.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1890.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1854.79, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1854.79, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1854.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1854.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1854.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1768.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1768.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1768.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1768.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1768.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1922.53, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1922.53, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1922.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1922.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1922.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR TREATMENT", "code_information": [{"code": "61770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1404.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1404.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1404.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1404.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1404.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL REPAIR", "code_information": [{"code": "62121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1591.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1591.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1591.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1591.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1591.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN BIOPSY", "code_information": [{"code": "61750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1311.77, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1311.77, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1311.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1311.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1311.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1092.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1092.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1092.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1092.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1092.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61735", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/SUTURES", "code_information": [{"code": "61556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1526.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1526.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1526.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1526.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1526.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/SUTURES", "code_information": [{"code": "61557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1591.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1591.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1591.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1591.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1591.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SPERM DUCT POUCH", "code_information": [{"code": "55600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SPERM DUCT POUCH", "code_information": [{"code": "55605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 518.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 518.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 518.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 518.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 518.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SPINAL CORD TRACT(S)", "code_information": [{"code": "63170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1413.07, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1413.07, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1413.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1413.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1413.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE ACCESSORY NERVE", "code_information": [{"code": "63191", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1167.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1167.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1167.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1167.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1167.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE NRV >2 SEGMNTS", "code_information": [{"code": "63190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1192.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1192.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1192.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1192.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1192.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE NRV HALF SEGMNT", "code_information": [{"code": "63185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1054.46, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1054.46, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1054.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1054.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1054.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE TEAR DUCT OPENING", "code_information": [{"code": "68440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 61.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE TENDON(S) & MUSCLE(S)", "code_information": [{"code": "23406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE THIGH TENDON & FASCIA", "code_information": [{"code": "27305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE WRIST/FOREARM TENDON", "code_information": [{"code": "25290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN EYELID LINING", "code_information": [{"code": "68020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR GLAND", "code_information": [{"code": "68400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR SAC", "code_information": [{"code": "68420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 198.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 198.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 198.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 198.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 198.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE/GRAFT MIDFOOT BONES", "code_information": [{"code": "28305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ACHILLES TENDON", "code_information": [{"code": "27605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ACHILLES TENDON", "code_information": [{"code": "27606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL ABSCESS", "code_information": [{"code": "46050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6120.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL SEPTUM", "code_information": [{"code": "46070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL SPHINCTER", "code_information": [{"code": "46080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANKLE BONE", "code_information": [{"code": "28302", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1225.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1225.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1225.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1225.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1225.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1238.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1238.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1238.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1238.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1238.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1993.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1993.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1993.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1993.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1993.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61567", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2368.91, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2368.91, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2368.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2368.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2368.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BROW NERVE", "code_information": [{"code": "64732", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BURN SCAB INITI", "code_information": [{"code": "16035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHEEK NERVE", "code_information": [{"code": "64734", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHIN NERVE", "code_information": [{"code": "64736", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF COLLARBONE JOINT", "code_information": [{"code": "23106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EARDRUM", "code_information": [{"code": "69420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EARDRUM", "code_information": [{"code": "69421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 534.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 534.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 534.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 534.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 534.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1279.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1279.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1279.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1279.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1279.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYE", "code_information": [{"code": "65850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYE", "code_information": [{"code": "66172", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID", "code_information": [{"code": "67710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 166.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 166.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 166.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 166.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 166.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID FOLD", "code_information": [{"code": "67715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FACIAL NERVE", "code_information": [{"code": "64742", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FIBULA", "code_information": [{"code": "27707", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FINGER TENDON", "code_information": [{"code": "26060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FINGER TENDON", "code_information": [{"code": "26455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT FASCIA", "code_information": [{"code": "28008", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT TENDON", "code_information": [{"code": "28234", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT TENDON(S)", "code_information": [{"code": "28230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 200.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 200.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 200.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 200.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 200.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 779.58, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 779.58, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 779.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 779.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 779.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 537.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 537.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 537.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 537.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 537.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 864.53, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 864.53, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 864.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 864.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 864.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEEL BONE", "code_information": [{"code": "28300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 19874.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONE", "code_information": [{"code": "27146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1253.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1253.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1253.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1253.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1253.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONES", "code_information": [{"code": "27151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1413.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1413.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1413.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1413.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1413.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27003", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 721.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 721.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 721.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 721.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 721.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDONS", "code_information": [{"code": "27006", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 731.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 731.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 731.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 731.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 731.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP/THIGH FASCIA", "code_information": [{"code": "27025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 873.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 873.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 873.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 873.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 873.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF IRIS", "code_information": [{"code": "66500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF IRIS", "code_information": [{"code": "66505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW JOINT", "code_information": [{"code": "21010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW NERVE", "code_information": [{"code": "64738", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF KNEE JOINT", "code_information": [{"code": "27435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF LARGE BOWEL", "code_information": [{"code": "44025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 895.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 895.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 895.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 895.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 895.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF LIP FOLD", "code_information": [{"code": "40806", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF LIVER DUCT", "code_information": [{"code": "47400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1938.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1938.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1938.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1938.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1938.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF LYMPH CHANNELS", "code_information": [{"code": "38308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 23324.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSALS", "code_information": [{"code": "28309", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF MIDFOOT BONES", "code_information": [{"code": "28304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF NECK OF FEMUR", "code_information": [{"code": "27161", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1211.48, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1211.48, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1211.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1211.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1211.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF PALM TENDON", "code_information": [{"code": "26450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF PROSTATE", "code_information": [{"code": "52450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF PYLORIC MUSCLE", "code_information": [{"code": "43520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 655.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 655.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 655.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 655.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 655.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6440.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF SMALL BOWEL", "code_information": [{"code": "44010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 786.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 786.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 786.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 786.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 786.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF SPERM DUCT", "code_information": [{"code": "55200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF SPINAL NERVE", "code_information": [{"code": "64772", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF STOMACH NERVES", "code_information": [{"code": "64755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 822.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 822.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 822.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 822.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 822.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TENDON & MUSCLE", "code_information": [{"code": "23405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TENDON SHEATH", "code_information": [{"code": "25000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27448", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 816.8, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 816.8, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 816.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 816.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 816.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1013.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1013.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1013.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1013.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1013.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDON", "code_information": [{"code": "27306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDON", "code_information": [{"code": "27390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27391", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27392", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TIBIA", "code_information": [{"code": "27705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TIBIA & FIBULA", "code_information": [{"code": "27709", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDON", "code_information": [{"code": "6908010", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5043.0, "discounted_cash": 3782.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDON", "code_information": [{"code": "6908010", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 5043.0, "discounted_cash": 3782.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDON", "code_information": [{"code": "28010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6999.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 96.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 96.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 96.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 96.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 96.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDON", "code_information": [{"code": "28232", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4627.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 191.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 191.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 191.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 191.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 191.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDONS", "code_information": [{"code": "6908011", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5043.0, "discounted_cash": 3782.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDONS", "code_information": [{"code": "6908011", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 5043.0, "discounted_cash": 3782.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDONS", "code_information": [{"code": "28011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 13541.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TONGUE FOLD", "code_information": [{"code": "41010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TONGUE NERVE", "code_information": [{"code": "64740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF VAGUS NERVE", "code_information": [{"code": "64760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 446.63, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 446.63, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 446.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 446.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 446.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 394.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 394.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 394.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 394.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 394.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 709.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 709.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 709.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 709.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 709.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WRIST CAPSULE", "code_information": [{"code": "25085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION SECONDARY CATARACT", "code_information": [{"code": "66820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION/FIXATION OF FEMUR", "code_information": [{"code": "27165", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1341.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1341.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1341.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1341.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1341.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISIONAL BX SKIN SGL LES", "code_information": [{"code": "6901108", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.0, "discounted_cash": 1398.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INCISIONAL BX SKIN SGL LES", "code_information": [{"code": "6901108", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1864.0, "discounted_cash": 1398.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INCOBOTULINUMTOXIN A PER 1U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0588", "type": "HCPCS"}, {"code": "5321293", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 5.01, "maximum": 5.57, "gross_charge": 24.0, "discounted_cash": 18.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCOBOTULINUMTOXIN A PER 1U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0588", "type": "HCPCS"}, {"code": "5321293", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.01, "maximum": 5.57, "gross_charge": 24.0, "discounted_cash": 18.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCOMPL DONOR EGG CASE RATE", "code_information": [{"code": "S4023", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCONTINENCE GARMENT ANYTYPE", "code_information": [{"code": "A4520", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IND 111 PENTTREOTDE DOSE", "code_information": [{"code": "A9572", "type": "HCPCS"}, {"code": "5199572", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 8754.78, "maximum": 9725.37, "gross_charge": 14228.0, "discounted_cash": 10671.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8754.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9725.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9725.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9725.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9725.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDAPAMIDE 1.25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305978", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INDAPAMIDE 1.25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305978", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INDEXING FOR OSTEOTOMY", "code_information": [{"code": "D7939", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INDIUM111 WBC DOSE", "code_information": [{"code": "A9570", "type": "HCPCS"}, {"code": "5199570", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 4319.42, "maximum": 4799.35, "gross_charge": 9212.0, "discounted_cash": 6909.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4319.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4799.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4799.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4799.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4799.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDOMETHACIN 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306000", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INDOMETHACIN 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306000", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INDOMETHACIN 75MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306008", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INDOMETHACIN 75MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306008", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 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"AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 45.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 20.5, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VACC ADMIN", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "6700008", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 12.81, "maximum": 51.67, "gross_charge": 61.0, "discounted_cash": 45.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 12.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 20.5, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VACC ADMIN", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "6920006", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 20.5, "maximum": 51.67, "gross_charge": 160.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 20.5, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VIRUS AB/2", "code_information": [{"code": "86710", "type": "CPT"}, {"code": "7256207", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.13, "gross_charge": 242.0, "discounted_cash": 181.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VIRUS VACCINE, NOS", "code_information": [{"code": "Q2039", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.14, "maximum": 12.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRARED THERAPY", "code_information": [{"code": "97026", "type": "CPT"}], "standard_charges": [{"minimum": 4.03, "maximum": 15.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRATEMPORAL APPROACH/SKULL", "code_information": [{"code": "61590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2989.78, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2989.78, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2989.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2989.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2989.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFRATEMPORAL APPROACH/SKULL", "code_information": [{"code": "61591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3015.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3015.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3015.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3015.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3015.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFUSE RADIOACTIVE MATERIALS", "code_information": [{"code": "77750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 388.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 225.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 349.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 350.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 349.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 349.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 349.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 349.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFUSION PUMP, NON-PROG,TEMP", "code_information": [{"code": "C2626", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUSION PUMP,NON-PROG, PERM", "code_information": [{"code": "C1891", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUSION THER OTHER THAN CHE", "code_information": [{"code": "Q0081", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE INI 120 MIN", "code_information": [{"code": "95076", "type": "CPT"}], "standard_charges": [{"minimum": 620.07, "maximum": 709.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC", "code_information": [{"code": "351", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5355.29, "maximum": 63783.56, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17509.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11310.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30759.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8920.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11900.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18423.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 32365.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9386.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12567.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9912.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 34177.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19455.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12567.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 34177.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19455.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9912.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12567.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9912.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 34177.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19455.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6521.59, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5355.29, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10841.04, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 18091.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50616.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63783.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC", "code_information": [{"code": "350", "type": "MS-DRG"}], "standard_charges": [{"minimum": 82736.06, "maximum": 104258.6, "estimated_discounted_cash": 184621.41, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 82736.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 104258.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "352", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38773.3, "maximum": 48859.58, "estimated_discounted_cash": 70242.22, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38773.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 48859.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INHIBIN A", "code_information": [{"code": "86336", "type": "CPT"}, {"code": "7256354", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 79.46, "gross_charge": 213.0, "discounted_cash": 159.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 79.46, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.77, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INHIBIN B", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "7253579", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.03, "gross_charge": 322.0, "discounted_cash": 241.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT CHEMO >8 PORT/PMP", "code_information": [{"code": "96416", "type": "CPT"}, {"code": "6291324", "type": "CDM"}, {"code": "335", "type": "RC"}], "standard_charges": [{"minimum": 209.33, "maximum": 449.16, "gross_charge": 2233.0, "discounted_cash": 1674.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 209.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 404.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 392.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 209.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 209.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 209.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 209.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT CHEMO >8 PORT/PMP", "code_information": [{"code": "96416", "type": "CPT"}, {"code": "6920273", "type": "CDM"}, {"code": "335", "type": "RC"}], "standard_charges": [{"minimum": 209.33, "maximum": 449.16, "gross_charge": 2233.0, "discounted_cash": 1674.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 209.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 404.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 392.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 209.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 209.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 209.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 209.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT DAY HOSP NEONATE CARE", "code_information": [{"code": "99477", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INIT/SUB PSYCH CARE M 1ST 30", "code_information": [{"code": "G2214", "type": "HCPCS"}], "standard_charges": [{"minimum": 101.37, "maximum": 115.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 104.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 101.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 115.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 115.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 115.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAL FOOT EXAM PT LOPS", "code_information": [{"code": "G0245", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INITIAL PREVENTIVE EXAM", "code_information": [{"code": "G0402", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INITIAL TREATMENT OF BURN(S)", "code_information": [{"code": "16000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ABSC/CYST PREV CATH", "code_information": [{"code": "4919424", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3693.0, "discounted_cash": 2769.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ABSC/CYST PREV CATH", "code_information": [{"code": "5059424", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3693.0, "discounted_cash": 2769.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "3100775", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 51.59, "maximum": 59.0, "gross_charge": 908.0, "discounted_cash": 681.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "4540775", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 51.59, "maximum": 59.0, "gross_charge": 760.0, "discounted_cash": 570.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "5606375", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 51.59, "maximum": 59.0, "gross_charge": 760.0, "discounted_cash": 570.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "6100775", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 51.59, "maximum": 59.0, "gross_charge": 908.0, "discounted_cash": 681.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "6160775", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 51.59, "maximum": 59.0, "gross_charge": 908.0, "discounted_cash": 681.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "6290775", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 51.59, "maximum": 59.0, "gross_charge": 908.0, "discounted_cash": 681.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "6920775", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 51.59, "maximum": 59.0, "gross_charge": 908.0, "discounted_cash": 681.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "6920775", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 51.59, "maximum": 59.0, "gross_charge": 908.0, "discounted_cash": 681.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ AIR/CM PERITNL CAV", "code_information": [{"code": "4917690", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4444.0, "discounted_cash": 3333.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ALLOPURINOL SODIUM 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0206", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.25, "maximum": 4.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ALYMSYS 10 MG", "code_information": [{"code": "Q5126", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.04, "maximum": 37.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 37.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 37.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 37.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 37.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ANDEXXA, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7169", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.25, "maximum": 142.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ANESTH CERV/THOR SGL", "code_information": [{"code": "4902325", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7555.0, "discounted_cash": 5666.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ANESTH CERV/THOR SGL", "code_information": [{"code": "4912313", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4336.0, "discounted_cash": 3252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ANESTH LUMB/CAUD SGL", "code_information": [{"code": "4902327", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6058.0, "discounted_cash": 4543.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ANESTH LUMB/CAUD SGL", "code_information": [{"code": "4912315", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6058.0, "discounted_cash": 4543.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ANESTH LUMB/CAUD SGL", "code_information": [{"code": "5057608", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6058.0, "discounted_cash": 4543.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ANIFROLUMAB-FNIA 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0491", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.27, "maximum": 18.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ANKLE ARTHROGRAM", "code_information": [{"code": "4907605", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1947.0, "discounted_cash": 1460.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ANKLE ARTHROGRAM", "code_information": [{"code": "4917605", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1947.0, "discounted_cash": 1460.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ARIPIPRAZOLE EXT REL 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0401", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.55, "maximum": 7.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ AVAL ALFA-NQPT 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0219", "type": "HCPCS"}], "standard_charges": [{"minimum": 72.82, "maximum": 80.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 72.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 80.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 80.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 80.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 80.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BETA INTERFERON IM 1 MCG", "code_information": [{"code": "Q3027", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.85, "maximum": 82.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 73.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 82.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 82.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 82.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 82.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BETA INTERFERON SQ 1 MCG", "code_information": [{"code": "Q3028", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.71, "maximum": 47.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 47.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 47.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 47.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 47.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BIMATOPROST ITC IMP1MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7351", "type": "HCPCS"}], "standard_charges": [{"minimum": 192.46, "maximum": 213.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 192.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 213.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 213.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 213.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 213.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BIPERIDEN LACTATE/5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0190", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.84, "maximum": 3.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BLADDER RETRO UR", "code_information": [{"code": "4907620", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2644.0, "discounted_cash": 1983.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ BLADDER RETRO UR", "code_information": [{"code": "4917620", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2644.0, "discounted_cash": 1983.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CEFAZOLIN SODIUM, HIKMA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0688", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.84, "maximum": 0.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CELIAC PLEXUS NRV", "code_information": [{"code": "5057605", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6058.0, "discounted_cash": 4543.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CERV/THOR EA ADD LVL", "code_information": [{"code": "4902326", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6058.0, "discounted_cash": 4543.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CERV/THOR EA ADD LVL", "code_information": [{"code": "4912314", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6058.0, "discounted_cash": 4543.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CHEMO ADD DRUG IVP", "code_information": [{"code": "96411", "type": "CPT"}, {"code": "4546411", "type": "CDM"}, {"code": "331", "type": "RC"}], "standard_charges": [{"minimum": 79.97, "maximum": 93.07, "gross_charge": 613.0, "discounted_cash": 459.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CHEMO ADD DRUG IVP", "code_information": [{"code": "96411", "type": "CPT"}, {"code": "6926411", "type": "CDM"}, {"code": "331", "type": "RC"}], "standard_charges": [{"minimum": 79.97, "maximum": 93.07, "gross_charge": 940.0, "discounted_cash": 705.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CHEMO INIT DRUG IVP", "code_information": [{"code": "96409", "type": "CPT"}, {"code": "4546409", "type": "CDM"}, {"code": "331", "type": "RC"}], "standard_charges": [{"minimum": 141.63, "maximum": 291.54, "gross_charge": 879.0, "discounted_cash": 659.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CHEMO INIT DRUG IVP", "code_information": [{"code": "96409", "type": "CPT"}, {"code": "6926409", "type": "CDM"}, {"code": "331", "type": "RC"}], "standard_charges": [{"minimum": 141.63, "maximum": 291.54, "gross_charge": 862.0, "discounted_cash": 646.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CLADRIBINE PER 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9065", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.61, "maximum": 10.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CM DACRYOCYSTOGRAPHY", "code_information": [{"code": "4907725", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3272.0, "discounted_cash": 2454.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CM EVAL DTUBE", "code_information": [{"code": "4909466", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CM EVAL GJTUBE", "code_information": [{"code": "4909468", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 844.0, "discounted_cash": 633.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CM EVAL GJTUBE", "code_information": [{"code": "4919468", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 562.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CM EVAL GTUBE", "code_information": [{"code": "4909465", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 766.0, "discounted_cash": 574.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CM EVAL GTUBE", "code_information": [{"code": "4919465", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 844.0, "discounted_cash": 633.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CM EVAL JTUBE", "code_information": [{"code": "4909467", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CRIZANLIZUMAB-TMCA 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0791", "type": "HCPCS"}], "standard_charges": [{"minimum": 116.53, "maximum": 129.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 116.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 129.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 129.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 129.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 129.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CROTALIDAE IM F(AB')2 EQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0841", "type": "HCPCS"}], "standard_charges": [{"minimum": 940.64, "maximum": 1045.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 940.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1045.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1045.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1045.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1045.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CUVITRU, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1555", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.16, "maximum": 16.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOS DR.REDDY'S 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9072", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.2, "maximum": 9.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOSPHAMD AUROMEDIC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9071", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DAUNORUBICIN, CYTARABINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9153", "type": "HCPCS"}], "standard_charges": [{"minimum": 230.48, "maximum": 256.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 230.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 256.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 256.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 256.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 256.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DEOXYCHOLIC ACID, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0591", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.39, "maximum": 17.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DUPUYTREN CORD W/ENZYME", "code_information": [{"code": "20527", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ EFGART-ALFA 2MG HYA-QVFC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9334", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.5, "maximum": 33.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EFGARTIGIMOD 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9332", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.94, "maximum": 32.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 32.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EFLAPEGRASTIM-XNST 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1449", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.78, "maximum": 20.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 20.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 20.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ELBOW ARTHROGRAM", "code_information": [{"code": "4907645", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4992.0, "discounted_cash": 3744.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ELBOW ARTHROGRAM", "code_information": [{"code": "4917645", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4992.0, "discounted_cash": 3744.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ENFORT VEDO-EJFV 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9177", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.07, "maximum": 36.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 33.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EPCORITAMAB-BYSP 0.16 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9321", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.26, "maximum": 55.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 55.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 55.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 55.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 55.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EPID BLD PATCH", "code_information": [{"code": "4900427", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4611.0, "discounted_cash": 3458.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ EPID BLD PATCH", "code_information": [{"code": "4912273", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4611.0, "discounted_cash": 3458.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ EPID CERV/THORC", "code_information": [{"code": "4902311", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6869.0, "discounted_cash": 5151.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ EPID CERV/THORC", "code_information": [{"code": "4912298", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6869.0, "discounted_cash": 5151.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ EPID LUMB/CAUD", "code_information": [{"code": "4900403", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6869.0, "discounted_cash": 5151.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ EPID LUMB/CAUD", "code_information": [{"code": "4910404", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6869.0, "discounted_cash": 5151.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ EVAL PREV PV SHUNT", "code_information": [{"code": "4919427", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8878.0, "discounted_cash": 6658.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ F/CYSTO OR VCUG", "code_information": [{"code": "4907615", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 135.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ F/CYSTO OR VCUG", "code_information": [{"code": "4917615", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1402.0, "discounted_cash": 1051.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ FE-BASED MR CONTRAST,1ML", "code_information": [{"code": "Q9953", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ FENSOLVI 0.25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1951", "type": "HCPCS"}], "standard_charges": [{"minimum": 126.89, "maximum": 140.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 126.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 140.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 140.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 140.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 140.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FERRIC CARBOXYMALTOS 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1439", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FERRIC PYROPHOSPHATE CIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1443", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FILGRASTIM EXCL BIOSIMIL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1442", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FOLLITROPIN ALFA 75 IU", "code_information": [{"code": "S0126", "type": "HCPCS"}], "standard_charges": [{"minimum": 247.79, "maximum": 275.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 247.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 275.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 275.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 275.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 275.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FOLLITROPIN BETA 75 IU", "code_information": [{"code": "S0128", "type": "HCPCS"}], "standard_charges": [{"minimum": 223.16, "maximum": 247.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 223.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 247.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 247.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 247.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 247.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FOR SACROILIAC JT ANESTH", "code_information": [{"code": "G0260", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14066.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FOR SIALOGRAPHY", "code_information": [{"code": "4907695", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3953.0, "discounted_cash": 2964.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ FOR SIALOGRAPHY", "code_information": [{"code": "4917695", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3953.0, "discounted_cash": 2964.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ FOSNETUPITANT, PALONOSET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1454", "type": "HCPCS"}], "standard_charges": [{"minimum": 517.95, "maximum": 575.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 517.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 575.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 575.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 575.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 575.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GALACTO/DUCTO PROC", "code_information": [{"code": "3071001", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 161.0, "discounted_cash": 120.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ GALACTO/DUCTO PROC", "code_information": [{"code": "4907630", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1504.0, "discounted_cash": 1128.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ GALACTO/DUCTO PROC", "code_information": [{"code": "5017630", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ GANIRELIX ACETAT 250 MCG", "code_information": [{"code": "S0132", "type": "HCPCS"}], "standard_charges": [{"minimum": 192.74, "maximum": 214.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 192.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 214.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 214.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 214.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 214.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GIVOSIRAN 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0223", "type": "HCPCS"}], "standard_charges": [{"minimum": 105.62, "maximum": 117.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 105.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 117.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 117.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 117.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 117.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GLOFITAMAB GXBM, 2.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9286", "type": "HCPCS"}], "standard_charges": [{"minimum": 2491.09, "maximum": 2767.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2491.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2767.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2767.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2767.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2767.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GLUCAGON HCL, FRESENIUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1611", "type": "HCPCS"}], "standard_charges": [{"minimum": 134.09, "maximum": 148.99, "estimated_discounted_cash": 1048.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 134.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 148.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 148.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 148.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 148.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HERZUMA 10 MG", "code_information": [{"code": "Q5113", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.43, "maximum": 69.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 62.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HIP ARTHRO W/O ANES", "code_information": [{"code": "4907650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ HIP ARTHRO W/O ANES", "code_information": [{"code": "4917650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 700.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ HIP ARTHROGRM W/ANES", "code_information": [{"code": "4907655", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5130.0, "discounted_cash": 3847.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ HIP ARTHROGRM W/ANES", "code_information": [{"code": "4917095", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2728.0, "discounted_cash": 2046.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ HUMAN FIBRINOGEN CON NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7178", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.37, "maximum": 1.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ IMIP 4 CILAS 4 RELEB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0742", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.35, "maximum": 2.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ INOTUZUMAB OZOGAM 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9229", "type": "HCPCS"}], "standard_charges": [{"minimum": 2428.25, "maximum": 2698.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2428.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2698.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2698.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2698.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2698.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ INTERCOSTL NERV SNGL", "code_information": [{"code": "4912299", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6685.0, "discounted_cash": 5013.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ INTERCOSTL NRV EA ADDL LVL", "code_information": [{"code": "4914422", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3682.0, "discounted_cash": 2761.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ IRINOTECAN LIPOSOME 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9205", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.4, "maximum": 66.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 59.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ IRON DEXTRAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1750", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.3, "maximum": 18.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LEVOCARNITINE PER 1 GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1955", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.25, "maximum": 23.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LON TESIRIN-LPYL 0.075MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9359", "type": "HCPCS"}], "standard_charges": [{"minimum": 195.21, "maximum": 216.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 195.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 216.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 216.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 216.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 216.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LUMB/CAUD EA ADD LVL", "code_information": [{"code": "4902328", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6058.0, "discounted_cash": 4543.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ LUMB/CAUD EA ADD LVL", "code_information": [{"code": "4912316", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6058.0, "discounted_cash": 4543.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ LYMPHANGIOGRAPHY", "code_information": [{"code": "4917680", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7132.0, "discounted_cash": 5349.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ MELPHA HYDROCH NOS 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9245", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.31, "maximum": 95.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 86.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MENOTROPINS 75 IU", "code_information": [{"code": "S0122", "type": "HCPCS"}], "standard_charges": [{"minimum": 259.02, "maximum": 287.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 259.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 287.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 287.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 287.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 287.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ METARAMINOL BITARTRATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0380", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.03, "maximum": 1.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MOGAMULIZUMAB-KPKC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9204", "type": "HCPCS"}], "standard_charges": [{"minimum": 223.65, "maximum": 248.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 223.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 248.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 248.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 248.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 248.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MOSUNETUZUMAB-AXGB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9350", "type": "HCPCS"}], "standard_charges": [{"minimum": 589.17, "maximum": 654.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 589.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 654.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 654.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 654.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 654.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MYELOGRAM LUMBAR", "code_information": [{"code": "4907685", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1851.0, "discounted_cash": 1388.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ MYELOGRAM LUMBAR", "code_information": [{"code": "4917685", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1851.0, "discounted_cash": 1388.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ NEPHROGRM EXIS ACC", "code_information": [{"code": "4917665", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6599.0, "discounted_cash": 4949.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ NEPHROSTOGRAM", "code_information": [{"code": "4910430", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4473.0, "discounted_cash": 3354.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ NIVOL RELATLIMAB 3MG/1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9298", "type": "HCPCS"}], "standard_charges": [{"minimum": 178.05, "maximum": 197.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 178.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 197.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 197.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 197.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 197.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ OCTAFLUOROPROPANE MIC,ML", "code_information": [{"code": "Q9956", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ OGIVRI 10 MG", "code_information": [{"code": "Q5114", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.26, "maximum": 40.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 40.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 40.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ OLIPUDASE ALFA-RPCP 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0218", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.29, "maximum": 393.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 354.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 393.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 393.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 393.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 393.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ONTRUZANT 10 MG", "code_information": [{"code": "Q5112", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.1, "maximum": 19.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PANTOPRAZOLE SODIUM, VIA", "code_information": [{"code": "C9113", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT C/T 1 LEV", "code_information": [{"code": "64490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT C/T 2 LEV", "code_information": [{"code": "64491", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT C/T 3 LEV", "code_information": [{"code": "64492", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT L/S 1 LEV", "code_information": [{"code": "64493", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17320.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT L/S 2 LEV", "code_information": [{"code": "64494", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT L/S 3 LEV", "code_information": [{"code": "64495", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEGFILGRASTIM-BMEZ 0.5MG", "code_information": [{"code": "Q5120", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.29, "maximum": 30.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (ACCORD) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9296", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.77, "maximum": 9.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (BLUEPOINT)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9322", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.34, "maximum": 10.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (TEVA) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9314", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.99, "maximum": 15.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED DITROMETHAMIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9323", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.12, "maximum": 0.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED, HOSPIRA 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9294", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.2, "maximum": 3.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PERC EXT PSEUDANYSM", "code_information": [{"code": "4636002", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1731.0, "discounted_cash": 1298.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ PERC EXT PSEUDANYSM", "code_information": [{"code": "4916002", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1997.0, "discounted_cash": 1497.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ PERFLEXANE LIP MICROS,ML", "code_information": [{"code": "Q9955", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PLASMINOGEN TVMH 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2998", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.22, "maximum": 41.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PROC KNEE ARTHROGRM", "code_information": [{"code": "4907670", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1153.0, "discounted_cash": 864.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ PROC KNEE ARTHROGRM", "code_information": [{"code": "4917670", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1153.0, "discounted_cash": 864.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ PROC SENTINEL NODE", "code_information": [{"code": "5208792", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3232.0, "discounted_cash": 2424.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ PROC SPLENOPORTGRAPHY", "code_information": [{"code": "4918203", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4992.0, "discounted_cash": 3744.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ PROTIRELIN PER 250 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2725", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.6, "maximum": 21.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PULM ART HRT CATH NONSLCT", "code_information": [{"code": "93568", "type": "CPT"}, {"code": "4613571", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 9627.3, "gross_charge": 10134.0, "discounted_cash": 7600.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2128.14, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 9627.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 9627.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3739.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 7600.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 7600.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PULM ART HRT CATH NONSLCT", "code_information": [{"code": "93568", "type": "CPT"}, {"code": "4613571", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 9627.3, "gross_charge": 10134.0, "discounted_cash": 7600.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2128.14, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 9627.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 9627.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3739.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 7600.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 7600.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RECOMBIN ESPEROCT PER IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7204", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RISANKIZUMAB-RZAA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2327", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.45, "maximum": 14.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RITUXIMAB, HYALURONIDASE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9311", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.02, "maximum": 36.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 33.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ROCTAVIAN ML 2X10^13VC G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1412", "type": "HCPCS"}], "standard_charges": [{"minimum": 12151.04, "maximum": 13501.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12151.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13501.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13501.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13501.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13501.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ROMIDEPSIN LYOPHIL 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9319", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.7, "maximum": 30.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ROMIDEPSIN NON-LYO 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9318", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.67, "maximum": 28.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 28.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RONZANOLIXIZUM-NOLI 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9333", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.85, "maximum": 23.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SCLRSANT SPIDER VN LMB/TRK", "code_information": [{"code": "4916468", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2281.0, "discounted_cash": 1710.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ SEBELIPASE ALFA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2840", "type": "HCPCS"}], "standard_charges": [{"minimum": 523.77, "maximum": 581.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 523.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 581.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 581.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 581.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 581.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SECRETIN SYNTHETIC HUMAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2850", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.39, "maximum": 47.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 47.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 47.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 47.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 47.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SHOULDER ARTHROGRAM", "code_information": [{"code": "4907700", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1141.0, "discounted_cash": 855.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ SHOULDER ARTHROGRAM", "code_information": [{"code": "4917700", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1141.0, "discounted_cash": 855.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ SINUS TRACT DIAGNSTC", "code_information": [{"code": "4907705", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4097.0, "discounted_cash": 3072.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ SINUS TRACT DIAGNSTC", "code_information": [{"code": "4917705", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4097.0, "discounted_cash": 3072.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ SINUS TRCT THERAPEUT", "code_information": [{"code": "4912317", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10474.0, "discounted_cash": 7855.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ SIROLIMUS PROT PART 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9331", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.11, "maximum": 84.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 76.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 84.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 84.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 84.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 84.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SNGL TENDON/LIGAMENT", "code_information": [{"code": "5060550", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2850.0, "discounted_cash": 2137.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ SODIUM THIOSULFATE 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0208", "type": "HCPCS"}], "standard_charges": [{"minimum": 93.71, "maximum": 104.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 93.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 104.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 104.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 104.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 104.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SPINE DISK CERV/THOR", "code_information": [{"code": "4907710", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3250.0, "discounted_cash": 2437.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ STREPTOKINASE /250000 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2995", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.55, "maximum": 79.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 79.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 79.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 79.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 79.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SULF HEXA LIPID MICROSPH", "code_information": [{"code": "Q9950", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TALIMOGENE LAHERPAREPVEC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9325", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.55, "maximum": 73.94, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 66.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 73.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 73.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 73.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 73.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TECLISTAMAB CQYV 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9380", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.22, "maximum": 33.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TEDIZOLID PHOSPHATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3090", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.76, "maximum": 1.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TENDON ORIGIN/INSERTION", "code_information": [{"code": "20551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TENDON SHEATH/LIGAMENT", "code_information": [{"code": "20550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7209.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TEPLIZUMAB MZWV 5 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9381", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.89, "maximum": 37.66, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 33.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 37.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 37.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 37.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 37.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TEZEPELUMAB-EKKO, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2356", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.21, "maximum": 18.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ THEOPHYLLINE PER 40 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2810", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.38, "maximum": 0.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TISOTU VEDOTIN-TFTV, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9273", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.88, "maximum": 188.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 169.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 188.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 188.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 188.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 188.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TMJ ARTHROGRAM", "code_information": [{"code": "4907660", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1499.0, "discounted_cash": 1124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ TOFERSEN INTRATHEC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1304", "type": "HCPCS"}], "standard_charges": [{"minimum": 143.46, "maximum": 159.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 143.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRASTUZUMAB EXCL BIOSIMI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.53, "maximum": 75.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 67.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 75.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 75.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 75.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 75.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRIAMCINOLONE ACE XR 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3304", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.47, "maximum": 18.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRIFERIC AVNU 0.1MG IRON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1445", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.18, "maximum": 0.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRIGGER POINT 1/2 MUSCL", "code_information": [{"code": "20552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TRIGGER PTS 1/2 MUSC", "code_information": [{"code": "4910552", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1623.0, "discounted_cash": 1217.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ TRIMETREXATE GLUCORONATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3305", "type": "HCPCS"}], "standard_charges": [{"minimum": 134.74, "maximum": 149.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 134.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 149.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 149.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 149.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 149.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX ART", "code_information": [{"code": "96373", "type": "CPT"}, {"code": "6296373", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 254.93, "maximum": 291.54, "gross_charge": 1474.0, "discounted_cash": 1105.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "3100782", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 81.38, "maximum": 93.07, "gross_charge": 557.0, "discounted_cash": 417.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "3536372", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 81.38, "maximum": 93.07, "gross_charge": 557.0, "discounted_cash": 417.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "4540330", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 81.38, "maximum": 93.07, "gross_charge": 419.0, "discounted_cash": 314.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "5606372", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 81.38, "maximum": 93.07, "gross_charge": 419.0, "discounted_cash": 314.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "6102120", 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"INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "6160772", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 81.38, "maximum": 93.07, "gross_charge": 557.0, "discounted_cash": 417.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "6700782", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 81.38, "maximum": 93.07, "gross_charge": 557.0, "discounted_cash": 417.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "6920782", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 81.38, "maximum": 93.07, "gross_charge": 557.0, "discounted_cash": 417.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "3100774", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 254.93, "maximum": 291.54, "gross_charge": 1235.0, "discounted_cash": 926.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "4540774", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 254.93, "maximum": 291.54, "gross_charge": 760.0, "discounted_cash": 570.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "5606374", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 254.93, "maximum": 291.54, "gross_charge": 760.0, "discounted_cash": 570.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "6100774", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 254.93, "maximum": 291.54, "gross_charge": 1235.0, "discounted_cash": 926.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "6160774", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 254.93, "maximum": 291.54, "gross_charge": 1235.0, "discounted_cash": 926.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "6290774", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 254.93, "maximum": 291.54, "gross_charge": 1474.0, "discounted_cash": 1105.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "6920774", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 254.93, "maximum": 291.54, "gross_charge": 1235.0, "discounted_cash": 926.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "6920774", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 254.93, "maximum": 291.54, "gross_charge": 1235.0, "discounted_cash": 926.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ UBLITUXIMAB-XIIY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2329", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.68, "maximum": 70.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 63.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 70.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 70.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 70.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 70.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ URETER/ILEAL CONDUIT", "code_information": [{"code": "4917735", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5866.0, "discounted_cash": 4399.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ URETERAL CATHETER", "code_information": [{"code": "4910684", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2542.0, "discounted_cash": 1906.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ VELMANASE ALFA-TYCV 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0217", "type": "HCPCS"}], "standard_charges": [{"minimum": 418.71, "maximum": 465.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 418.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 465.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 465.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 465.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 465.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ VENOGRPHY EXTRMTY", "code_information": [{"code": "4617690", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1948.0, "discounted_cash": 1461.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ VENOGRPHY EXTRMTY", "code_information": [{"code": "4916005", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1948.0, "discounted_cash": 1461.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ W/FLUOR EVAL CV DEVICE", "code_information": [{"code": "36598", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1489.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ WRIST ARTHROGRAM", "code_information": [{"code": "4907745", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4243.0, "discounted_cash": 3182.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ WRIST ARTHROGRAM", "code_information": [{"code": "4917745", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4243.0, "discounted_cash": 3182.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ XIPERE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3299", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.17, "maximum": 47.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 43.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 47.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 47.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 47.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 47.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ&CATH HYSTER/SONOHYST", "code_information": [{"code": "4907740", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1495.0, "discounted_cash": 1121.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ&CATH HYSTER/SONOHYST", "code_information": [{"code": "4917740", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1495.0, "discounted_cash": 1121.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ&CATH HYSTER/SONOHYST", "code_information": [{"code": "5067740", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1495.0, "discounted_cash": 1121.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ, ABILIFY ASIMTUFII, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0402", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.43, "maximum": 6.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ADO-TRASTUZUMAB EMT 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9354", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.94, "maximum": 42.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 42.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 42.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 42.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 42.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ADUCANUMAB-AVWA, 2 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0172", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.38, "maximum": 5.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, AFSTYLA, 1 I.U.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7210", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.41, "maximum": 1.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, AMIODARONE (NEXTERONE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0283", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.35, "maximum": 2.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, AMISULPRIDE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0184", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.79, "maximum": 10.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, AMIVANTAMAB-VMJW", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9061", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.29, "maximum": 22.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 22.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 22.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 22.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, APONVIE, 1 MG", "code_information": [{"code": "C9145", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.96, "maximum": 2.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ARTESUNATE, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0391", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.17, "maximum": 55.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 50.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 55.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 55.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 55.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 55.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ASPARA, RYLAZE, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9021", "type": "HCPCS"}], "standard_charges": [{"minimum": 49.92, "maximum": 55.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 49.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 55.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 55.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 55.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 55.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BENDAMUSTINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9056", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.87, "maximum": 29.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BEZLOTOXUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0565", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.85, "maximum": 39.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 35.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 39.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB (MAIA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9051", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.51, "maximum": 3.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB, DR. REDDY'S", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9046", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.99, "maximum": 52.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BROLUCIZUMAB-DBLL, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0179", "type": "HCPCS"}], "standard_charges": [{"minimum": 311.5, "maximum": 346.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 311.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 346.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 346.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 346.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 346.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BUPIVACAINE (POSIMIR)", "code_information": [{"code": "C9144", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BUPIVACAINE LIPOSOME", "code_information": [{"code": "C9290", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, CABAZITAXEL (SANDOZ)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9064", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.54, "maximum": 221.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 199.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 221.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 221.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 221.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 221.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CABOTE RILPIVIR 2MG 3MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0741", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.29, "maximum": 23.65, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CARMUSTINE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9052", "type": "HCPCS"}], "standard_charges": [{"minimum": 251.37, "maximum": 279.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 251.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 279.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 279.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 279.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 279.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CEFIDEROCOL, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0699", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.18, "maximum": 2.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CIMERLI, 0.1 MG", "code_information": [{"code": "Q5128", "type": "HCPCS"}], "standard_charges": [{"minimum": 77.54, "maximum": 86.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 77.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 86.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 86.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 86.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 86.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CLEVIDIPINE BUTYRATE", "code_information": [{"code": "C9248", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0874", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (XELLIA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0873", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DOSTARLIMAB-GXLY, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9272", "type": "HCPCS"}], "standard_charges": [{"minimum": 219.34, "maximum": 243.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 219.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 243.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 243.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 243.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 243.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DUROLANE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7318", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.09, "maximum": 6.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ELAHERE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9063", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.54, "maximum": 69.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 62.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 69.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 69.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 69.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 69.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ETEPLIRSEN, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1428", "type": "HCPCS"}], "standard_charges": [{"minimum": 164.16, "maximum": 182.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 164.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 182.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 182.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 182.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 182.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, EVINACUMAB-DGNB, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1305", "type": "HCPCS"}], "standard_charges": [{"minimum": 174.38, "maximum": 193.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 174.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 193.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 193.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 193.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 193.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FACTOR X, (HUMAN), 1IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7175", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.8, "maximum": 9.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FARICIMAB-SVOA, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2777", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.49, "maximum": 33.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FOSAPREPITANT (TEVA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1456", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.93, "maximum": 1.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FULVESTRANT (FRESENIUS)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9394", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.09, "maximum": 26.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 26.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 26.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 26.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FULVESTRANT (TEVA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9393", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.52, "maximum": 22.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FUROSCIX, 20 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1941", "type": "HCPCS"}], "standard_charges": [{"minimum": 251.52, "maximum": 279.47, "setting": "outpatient", "payers_information": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 572.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 572.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 572.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, PEGCETACOPLAN, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2781", "type": "HCPCS"}], "standard_charges": [{"minimum": 125.26, "maximum": 139.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 125.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 139.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 139.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 139.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 139.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, PEMRYDI RTU, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9324", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.23, "maximum": 75.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 68.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 75.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 75.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 75.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 75.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, POLATUZUMAB VEDOTIN 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9309", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.0, "maximum": 136.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 123.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 136.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 136.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 136.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 136.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, RELEUKO 1 MCG", "code_information": [{"code": "Q5125", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.34, "maximum": 0.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, RETIFANLIMAB-DLWR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9345", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.5, "maximum": 30.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, REZAFUNGIN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0349", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.57, "maximum": 10.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, RIMABOTULINUMTOXINB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0587", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.96, "maximum": 13.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SCULPTRA, 0.5MG", "code_information": [{"code": "Q2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.84, "maximum": 0.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SEZABY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2561", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.37, "maximum": 1.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SPESOLIMAB-SBZO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1747", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.16, "maximum": 65.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 59.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 65.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 65.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 65.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 65.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, STIMUFEND, 0.5 MG", "code_information": [{"code": "Q5127", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.42, "maximum": 184.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 166.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 184.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 184.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 184.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 184.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SUSVIMO 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2779", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.04, "maximum": 78.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 78.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 78.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 78.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 78.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SUTIMLIMAB-JOME, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1302", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.97, "maximum": 18.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TALIGLUCERASE ALFA 10 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3060", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.0, "maximum": 41.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 41.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 41.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 41.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 41.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TEBENTAFUSP-TEBN, 1 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9274", "type": "HCPCS"}], "standard_charges": [{"minimum": 195.38, "maximum": 217.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 195.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 217.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 217.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 217.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 217.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TREMELIMUMAB-ACTL, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9347", "type": "HCPCS"}], "standard_charges": [{"minimum": 126.81, "maximum": 140.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 126.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 140.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 140.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 140.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 140.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TRIVISC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7329", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.22, "maximum": 4.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, UZEDY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2799", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.54, "maximum": 25.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 22.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 25.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 25.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VEGZELMA, 10 MG", "code_information": [{"code": "Q5129", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.96, "maximum": 39.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 35.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VUTRISIRAN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0225", "type": "HCPCS"}], "standard_charges": [{"minimum": 4503.28, "maximum": 5003.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4503.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5003.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5003.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5003.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5003.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ZIV-AFLIBERCEPT, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9400", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.09, "maximum": 7.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. ASCENIV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1554", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.07, "maximum": 496.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 447.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 496.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 496.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 496.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 496.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. AVSOLA, 10 MG", "code_information": [{"code": "Q5121", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.37, "maximum": 20.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 20.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 20.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. BELRAPZO/BENDAMUSTINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9036", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.05, "maximum": 12.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. BYOOVIZ, 0.1 MG", "code_information": [{"code": "Q5124", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.62, "maximum": 61.8, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 55.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 61.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 61.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 61.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 61.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. CALASPARGASE PEGOL-MKNL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9118", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.87, "maximum": 82.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 73.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. CETIRIZINE HCL 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1201", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.87, "maximum": 16.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. EPTINEZUMAB-JJMR 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3032", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.97, "maximum": 19.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. FE DERISOMALTOSE 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1437", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.82, "maximum": 22.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. HERCEPTIN HYLECTA, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9356", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.3, "maximum": 61.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 61.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 61.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 61.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 61.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INEBILIZUMAB-CDON, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1823", "type": "HCPCS"}], "standard_charges": [{"minimum": 446.0, "maximum": 495.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 446.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 495.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 495.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 495.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 495.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INFUGEM, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9198", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.99, "maximum": 43.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 38.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 43.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 43.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 43.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INSULIN (LYUMJEV)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1814", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.41, "maximum": 1.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. ISATUXIMAB-IRFC 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9227", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.71, "maximum": 81.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 73.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. JIVI 1 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7208", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.39, "maximum": 2.65, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. LUMASIRAN, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0224", "type": "HCPCS"}], "standard_charges": [{"minimum": 296.15, "maximum": 329.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 296.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 329.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 329.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 329.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 329.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. LURBINECTEDIN, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9223", "type": "HCPCS"}], "standard_charges": [{"minimum": 186.42, "maximum": 207.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 186.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 207.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 207.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 207.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 207.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. MARGETUXIMAB-CMKB, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9353", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.24, "maximum": 52.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 47.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 52.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. NAXITAMAB-GQGK, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9348", "type": "HCPCS"}], "standard_charges": [{"minimum": 617.4, "maximum": 686.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 617.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 686.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 686.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 686.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 686.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9304", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.69, "maximum": 46.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 41.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 46.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 46.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 46.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 46.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. RIABNI, 10 MG", "code_information": [{"code": "Q5123", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.86, "maximum": 26.51, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 23.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. ROMOSOZUMAB-AQQG 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3111", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.86, "maximum": 12.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. TAGRAXOFUSP-ERZS 10 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9269", "type": "HCPCS"}], "standard_charges": [{"minimum": 321.24, "maximum": 356.93, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 321.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 356.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 356.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 356.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 356.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. TEPROTUMUMAB-TRBW 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3241", "type": "HCPCS"}], "standard_charges": [{"minimum": 323.27, "maximum": 359.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 323.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 359.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 359.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 359.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 359.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. XEMBIFY, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1558", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.37, "maximum": 14.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., APREPITANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0185", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.48, "maximum": 1.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ARISTADA INITIO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1943", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.93, "maximum": 3.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., BENRALIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 148.13, "maximum": 164.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 148.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 164.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 164.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 164.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 164.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., CEMIPLIMAB-RWLC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9119", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.36, "maximum": 29.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., CERLIPONASE ALFA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0567", "type": "HCPCS"}], "standard_charges": [{"minimum": 120.29, "maximum": 133.65, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 120.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 133.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 133.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 133.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 133.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., COPANLISIB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9057", "type": "HCPCS"}], "standard_charges": [{"minimum": 89.84, "maximum": 99.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 89.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 99.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 99.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 99.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 99.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., DURVALUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9173", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.61, "maximum": 85.12, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 76.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 85.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 85.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 85.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 85.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., EMAPALUMAB-LZSG, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9210", "type": "HCPCS"}], "standard_charges": [{"minimum": 346.37, "maximum": 384.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 346.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 384.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 384.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 384.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 384.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., EMICIZUMAB-KXWH 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7170", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.49, "maximum": 56.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 50.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., EVOMELA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9246", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.65, "maximum": 18.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., FIBRYGA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7177", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.11, "maximum": 1.23, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., GUSELKUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1628", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.37, "maximum": 75.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 68.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 75.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 75.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 75.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 75.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., HAEGARDA 10 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0599", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.41, "maximum": 13.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., IBALIZUMAB-UIYK, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1746", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.33, "maximum": 79.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 79.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 79.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 79.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 79.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ILUVIEN, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7313", "type": "HCPCS"}], "standard_charges": [{"minimum": 448.33, "maximum": 498.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 448.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 498.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 498.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 498.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 498.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., LANADELUMAB-FLYO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0593", "type": "HCPCS"}], "standard_charges": [{"minimum": 78.55, "maximum": 87.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 87.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., LUMOXITI, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9313", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.64, "maximum": 25.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 22.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., MEROPENEM, VABORBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2186", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.29, "maximum": 2.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., OMADACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0121", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.62, "maximum": 4.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., PATISIRAN, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0222", "type": "HCPCS"}], "standard_charges": [{"minimum": 89.97, "maximum": 99.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 89.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 99.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 99.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 99.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 99.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., PERSERIS, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2798", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.93, "maximum": 12.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., PLAZOMICIN, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0291", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.15, "maximum": 3.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., RAVULIZUMAB-CWVZ 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1303", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.6, "maximum": 225.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 202.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 225.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 225.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 225.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 225.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., RETISERT, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7311", "type": "HCPCS"}], "standard_charges": [{"minimum": 306.28, "maximum": 340.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 306.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 340.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 340.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 340.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 340.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., RITUXIMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9312", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.7, "maximum": 75.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 67.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 75.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 75.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 75.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 75.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ROLAPITANT, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2797", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.91, "maximum": 1.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TAFASITAMAB-CXIX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9349", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.88, "maximum": 14.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TILDRAKIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3245", "type": "HCPCS"}], "standard_charges": [{"minimum": 114.71, "maximum": 127.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 114.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 127.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 127.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 127.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 127.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TRAZIMERA, 10 MG", "code_information": [{"code": "Q5116", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.19, "maximum": 27.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 27.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TREANDA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9033", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.69, "maximum": 1.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TRILURON, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7332", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.24, "maximum": 10.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TRIPTORELIN XR 3.75 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3316", "type": "HCPCS"}], "standard_charges": [{"minimum": 3435.55, "maximum": 3817.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3435.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3817.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3817.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3817.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3817.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., VESTRONIDASE ALFA-VJBK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3397", "type": "HCPCS"}], "standard_charges": [{"minimum": 278.66, "maximum": 309.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 278.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 309.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 309.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 309.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 309.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., YUTIQ, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7314", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.9, "maximum": 529.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 476.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 529.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 529.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 529.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 529.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ZIRABEV, 10 MG", "code_information": [{"code": "Q5118", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.19, "maximum": 25.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 23.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 25.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 25.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT EPIDURAL PATCH", "code_information": [{"code": "62273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT FOR LYMPHATIC X-RAY", "code_information": [{"code": "38790", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 82.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 82.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 82.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 82.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 82.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT FOR SACROILIAC JOINT", "code_information": [{"code": "G0259", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT PROC SACRO JNT", "code_information": [{"code": "4907096", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6444.0, "discounted_cash": 4833.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECT PROC SACRO JNT", "code_information": [{"code": "4917096", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6444.0, "discounted_cash": 4833.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECT PROC SACRO JNT", "code_information": [{"code": "5057096", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6444.0, "discounted_cash": 4833.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECT SACROILIAC JOINT", "code_information": [{"code": "27096", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 208.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 208.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 208.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 208.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 208.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT SINUS TRACT FOR X-RAY", "code_information": [{"code": "20501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 148.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 148.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 148.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 148.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 148.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS </W 7", "code_information": [{"code": "11900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS >7", "code_information": [{"code": "11901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT SPINE DISK LMBR", "code_information": [{"code": "4917715", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2166.0, "discounted_cash": 1624.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECT TRIGGER POINTS 3/>", "code_information": [{"code": "20553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT-PLT RICH PLASMA", "code_information": [{"code": "232T", "type": "CPT"}, {"code": "3210232", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "gross_charge": 3133.0, "discounted_cash": 2349.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 657.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 2976.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 2976.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1156.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 2349.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 2349.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT/ASPIRATE LIVER CYST", "code_information": [{"code": "47015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1042.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1042.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1042.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1042.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1042.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION ABDOMINAL SHUNT", "code_information": [{"code": "49427", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION ANISTREPLASE 30 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0350", "type": "HCPCS"}], "standard_charges": [{"minimum": 2041.61, "maximum": 2268.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2041.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2268.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2268.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2268.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2268.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ESTRONE PER 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1435", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.22, "maximum": 0.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION EXT VENOGRAPHY", "code_information": [{"code": "36005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 404.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 404.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 404.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 404.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 404.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION EYE DRUG", "code_information": [{"code": "67028", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR ANKLE X-RAY", "code_information": [{"code": "27648", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 182.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 182.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 182.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 182.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 182.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDER X-RAY", "code_information": [{"code": "51600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 245.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 245.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 245.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 245.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 245.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDER X-RAY", "code_information": [{"code": "51610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 134.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 134.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 134.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 134.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 134.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1623.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47532", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR HIP X-RAY", "code_information": [{"code": "27093", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 700.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 223.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 223.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 223.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 223.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 223.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR HIP X-RAY", "code_information": [{"code": "27095", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 272.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 272.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 272.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 272.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 272.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR MYELOGRAM", "code_information": [{"code": "62284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 258.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 258.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 258.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 258.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 258.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SALIVARY X-RAY", "code_information": [{"code": "42550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 171.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 171.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 171.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 171.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 171.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SHOULDER X-RAY", "code_information": [{"code": "23350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 178.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 178.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 178.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 178.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 178.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SPLEEN X-RAY", "code_information": [{"code": "38200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 139.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 139.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 139.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 139.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 139.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR TEAR SAC X-RAY", "code_information": [{"code": "68850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50684", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 233.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 233.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 233.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 233.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 233.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 117.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 117.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 117.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 117.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 117.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR WRIST X-RAY", "code_information": [{"code": "25246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 194.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 194.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 194.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 194.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 194.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO BRAIN CANAL", "code_information": [{"code": "61026", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO BRAIN CANAL", "code_information": [{"code": "61055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 20574.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO HEMORRHOID(S)", "code_information": [{"code": "46500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 105.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 105.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 105.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 105.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 105.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO SPINAL ARTERY", "code_information": [{"code": "62294", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO VOCAL CORD", "code_information": [{"code": "31513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTRAOP ADD-ON", "code_information": [{"code": "48400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 100.99, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 100.99, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 100.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 100.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 100.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION JAW JOINT X-RAY", "code_information": [{"code": "21116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 186.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 186.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 186.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 186.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 186.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION OF HIV PREP DRUG", "code_information": [{"code": "G0012", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.73, "maximum": 79.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 79.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 79.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 79.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 79.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION OF SINUS TRACT", "code_information": [{"code": "20500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION PANTROPRAZOLE", "code_information": [{"code": "S0164", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION PX FOR ELBOW ARTHG", "code_information": [{"code": "24220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 192.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 192.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 192.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 192.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 192.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TORSEMIDE 10 MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3265", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.97, "maximum": 2.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TRABECTEDIN 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9352", "type": "HCPCS"}], "standard_charges": [{"minimum": 351.96, "maximum": 391.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 351.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 391.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 391.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 391.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 391.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF EYE", "code_information": [{"code": "66020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF EYE", "code_information": [{"code": "66030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 121.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 121.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 121.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 121.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 121.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64681", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NOSE", "code_information": [{"code": "30200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION, ALEMTUZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0202", "type": "HCPCS"}], "standard_charges": [{"minimum": 2186.9, "maximum": 2429.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2186.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2429.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2429.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2429.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2429.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, AMINOCAPROIC ACID", "code_information": [{"code": "S0017", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, AVELUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9023", "type": "HCPCS"}], "standard_charges": [{"minimum": 90.08, "maximum": 100.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 90.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 100.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 100.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 100.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 100.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, BELINOSTAT, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9032", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.22, "maximum": 52.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 47.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 52.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, BLINATUMOMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9039", "type": "HCPCS"}], "standard_charges": [{"minimum": 147.83, "maximum": 164.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 147.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, BUROSUMAB-TWZA 1M", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0584", "type": "HCPCS"}], "standard_charges": [{"minimum": 435.73, "maximum": 484.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 435.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 484.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 484.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 484.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 484.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, CARFILZOMIB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9047", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.09, "maximum": 55.65, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 50.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 55.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 55.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 55.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 55.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, CASIMERSEN, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1426", "type": "HCPCS"}], "standard_charges": [{"minimum": 164.16, "maximum": 182.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 164.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 182.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 182.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 182.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 182.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, CEFOPERAZONE SOD", "code_information": [{"code": "S0021", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.39, "maximum": 17.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17.1, "methodology": "fee 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"type": "EA"}, "code_information": [{"code": "J0875", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.05, "maximum": 15.61, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, DARATUMUMAB 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9145", "type": "HCPCS"}], "standard_charges": [{"minimum": 64.23, "maximum": 71.37, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 64.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 71.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 71.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 71.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 71.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, DELAFLOXACIN", "code_information": [{"code": "C9462", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.51, "maximum": 0.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, EDARAVONE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1301", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.89, "maximum": 20.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 20.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 20.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, ELOTUZUMAB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9176", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.1, "maximum": 7.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, FAMOTIDINE, 20 MG", "code_information": [{"code": "S0028", "type": "HCPCS"}], "standard_charges": [{"estimated_discounted_cash": 4.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, FOSPHENYTOIN SODI", "code_information": [{"code": "S0078", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.87, "maximum": 42.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 42.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 42.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 42.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 42.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, GLUCARPIDASE", "code_information": [{"code": "C9293", "type": "HCPCS"}], "standard_charges": [{"minimum": 443.57, "maximum": 492.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 443.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 492.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 492.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 492.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 492.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, INCLISIRAN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1306", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.09, "maximum": 12.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, INFLECTRA", "code_information": [{"code": "Q5103", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.99, "maximum": 19.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19.99, "methodology": "fee 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"standard_charge_dollar": 1.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, LACOSAMIDE", "code_information": [{"code": "C9254", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, MEPOLIZUMAB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2182", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.14, "maximum": 31.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 28.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, NAFCILLIN SODIUM", "code_information": [{"code": "S0032", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", 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CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, OFLOXACIN, 400 MG", "code_information": [{"code": "S0034", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.57, "maximum": 25.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 22.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 25.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 25.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, ORITAVANCIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2407", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.81, "maximum": 28.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, ORITAVANCIN 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2406", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.23, "maximum": 42.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 38.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 42.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 42.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 42.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 42.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, PERAMIVIR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2547", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.63, "maximum": 1.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, PIPERACILLIN SODI", "code_information": [{"code": "S0081", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.88, "maximum": 2.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, RAMUCIRUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9308", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.92, "maximum": 74.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 74.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 74.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 74.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 74.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, RESLIZUMAB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2786", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.86, "maximum": 10.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, RUCONEST", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0596", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.09, "maximum": 36.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 33.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, SILTUXIMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2860", "type": "HCPCS"}], "standard_charges": [{"minimum": 149.25, "maximum": 165.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 165.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, SULFAMETHOXAZOLE", "code_information": [{"code": "S0039", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, TICARCILLIN DISOD", "code_information": [{"code": "S0040", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.03, "maximum": 16.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding 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"code_information": [{"code": "J1448", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.91, "maximum": 5.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, UDENYCA 0.5 MG", "code_information": [{"code": "Q5111", "type": "HCPCS"}], "standard_charges": [{"minimum": 95.7, "maximum": 106.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 95.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 106.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 106.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 106.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 106.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, VEDOLIZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3380", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.18, "maximum": 21.31, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, ZARXIO", "code_information": [{"code": "Q5101", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNER SKULL VESSEL SURGERY", "code_information": [{"code": "61702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3599.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3599.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3599.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3599.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3599.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INPNT STAY RADIOLABELED ITEM", "code_information": [{"code": "C9898", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT IMPLANT PROS DEV,NO COV", "code_information": [{"code": "C9899", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT30", "code_information": [{"code": "G0425", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT50", "code_information": [{"code": "G0426", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT70", "code_information": [{"code": "G0427", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 15", "code_information": [{"code": "G0406", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 25", "code_information": [{"code": "G0407", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 35", "code_information": [{"code": "G0408", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS AICD W/DUAL LDS", "code_information": [{"code": "4613230", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 182250.0, "discounted_cash": 136687.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS AICD W/MULTI LDS", "code_information": [{"code": "4613231", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 162351.0, "discounted_cash": 121763.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS BONE DEVICE FOR RSA", "code_information": [{"code": "347T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4898.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 1ST", "code_information": [{"code": "36245", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1570.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1570.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1570.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1570.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1570.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 2ND", "code_information": [{"code": "36246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1513.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1513.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1513.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1513.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1513.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 3RD", "code_information": [{"code": "36247", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2409.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2409.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2409.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2409.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2409.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART ADDL", "code_information": [{"code": "36248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BIL", "code_information": [{"code": "4616252", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13680.0, "discounted_cash": 10260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BIL", "code_information": [{"code": "4916252", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13680.0, "discounted_cash": 10260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BILAT", "code_information": [{"code": "36252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNI", "code_information": [{"code": "4616251", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10040.0, "discounted_cash": 7530.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNI", "code_information": [{"code": "4916251", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10040.0, "discounted_cash": 7530.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNILAT", "code_information": [{"code": "36251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND BIL", "code_information": [{"code": "4916254", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16140.0, "discounted_cash": 12105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND UNI", "code_information": [{"code": "4616253", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19630.0, "discounted_cash": 14722.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND UNI", "code_information": [{"code": "4916253", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13680.0, "discounted_cash": 10260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ BILAT", "code_information": [{"code": "36254", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ UNILAT", "code_information": [{"code": "36253", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS DEVICE FOR RT GUIDE OPEN", "code_information": [{"code": "49412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS ENDOVA VENACAVA FILT", "code_information": [{"code": "4617191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21507.0, "discounted_cash": 16130.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS ENDOVA VENACAVA FILT", "code_information": [{"code": "4917191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 14938.0, "discounted_cash": 11203.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37191", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS LV LD W/PM OR AICD", "code_information": [{"code": "4613225", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 41506.0, "discounted_cash": 31129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS MARK ABD/PEL FOR RT PERQ", "code_information": [{"code": "49411", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS MARK THOR FOR RT PERQ", "code_information": [{"code": "32553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61889", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS TUN IP CATH FOR DIAL OPN", "code_information": [{"code": "49421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1372.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1372.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1372.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1372.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1372.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS TUNN INTRAPER CATH", "code_information": [{"code": "4919418", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12244.0, "discounted_cash": 9183.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS VAG BRACHYTX DEVICE", "code_information": [{"code": "57156", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/PM GEN W/EXIST LD", "code_information": [{"code": "4613212", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 50439.0, "discounted_cash": 37829.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/PMGEN W/EXISDUALLDS", "code_information": [{"code": "4612505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 40997.0, "discounted_cash": 30747.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/REP SUBQ DEFIBRILLATOR", "code_information": [{"code": "33270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "estimated_discounted_cash": 65160.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/RPL PM W/TRNSV LD AT", "code_information": [{"code": "4613206", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 39495.0, "discounted_cash": 29621.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/RPL PM W/TRNSV LD VE", "code_information": [{"code": "4613207", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 34756.0, "discounted_cash": 26067.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/RPL PMW/TRNSV LD A-V", "code_information": [{"code": "4613208", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 70376.0, "discounted_cash": 52782.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/RPL PMW/TRNSV LD A-V", "code_information": [{"code": "4913208", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 70376.0, "discounted_cash": 52782.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/RPL PRPH SAC/GSTR NPG/R", "code_information": [{"code": "64590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15991.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12045.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12045.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12045.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12045.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12045.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/RPL TEMP LEADS DUAL", "code_information": [{"code": "4613211", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 26442.0, "discounted_cash": 19831.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/RPLC SPI NPG/RCVR POCKET", "code_information": [{"code": "63685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15677.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15677.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15677.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15677.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15677.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15677.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/RPLCM PRQ ELTRD RA PN EA", "code_information": [{"code": "64597", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/RPLCMT PRQ ELTRD RA PN 1", "code_information": [{"code": "64596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/RPLMT ELTRD RA SPI NSTIM", "code_information": [{"code": "784T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSEMINATION OF OOCYTES", "code_information": [{"code": "89268", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 1 ELECTRODE PM-DEFIB", "code_information": [{"code": "33216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT 2 ELECTRODE PM-DEFIB", "code_information": [{"code": "33217", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ABDOMEN-VENOUS DRAIN", "code_information": [{"code": "49425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 710.71, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 710.71, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 710.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 710.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 710.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT AND REMOVE BONE PIN", "code_information": [{"code": "20650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ANT DRAINAGE DEVICE", "code_information": [{"code": "66183", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT AQUEOUS DRAIN DEVICE", "code_information": [{"code": "253T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ARTICULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1581.72, "maximum": 1581.72, "gross_charge": 7532.0, "discounted_cash": 5649.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1581.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT BALLOON DEVICE", "code_information": [{"code": "33973", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT BLADDER CATH COMPLEX", "code_information": [{"code": "51703", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT BLADDER CATHETER", "code_information": [{"code": "51701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1310.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT BRAIN-FLUID DEVICE", "code_information": [{"code": "61215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CARD ELECTRODES DUAL", "code_information": [{"code": "33211", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/ IMAGE", "code_information": [{"code": "32557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/O IMAGE", "code_information": [{"code": "32556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CERVICAL DILATOR", "code_information": [{"code": "59200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CV CATH INF & SUP APP", "code_information": [{"code": "C9780", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT DRUG DEL IMPLANT, >=4", "code_information": [{"code": "G0516", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRD/PM CATH SNGL", "code_information": [{"code": "33210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4047.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRODES FOR EEG", "code_information": [{"code": "95830", "type": "CPT"}], "standard_charges": [{"minimum": 184.7, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 205.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 184.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.22, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 205.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 205.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 205.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 205.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EMERGENCY AIRWAY", "code_information": [{"code": "31500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2716.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 109.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 109.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 109.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 109.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 109.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ENDOVASC PROSTH TAA", "code_information": [{"code": "33883", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1157.8, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1157.8, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1157.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1157.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1157.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD ENDO", "code_information": [{"code": "33203", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 799.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 799.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 799.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 799.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 799.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD OPEN", "code_information": [{"code": "33202", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 780.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 780.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 780.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 780.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 780.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT EYE SOCKET IMPLANT", "code_information": [{"code": "67550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEART PM ATRIAL", "code_information": [{"code": "33206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7572.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7572.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7572.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7572.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7572.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEART PM VENTRICULAR", "code_information": [{"code": "33207", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "estimated_discounted_cash": 64565.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7572.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7572.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7572.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7572.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7572.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEPATIC SHUNT (TIPS)", "code_information": [{"code": "37182", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 894.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 894.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 894.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 894.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 894.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEYMAN UTERI CAPSULE", "code_information": [{"code": "58346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL STD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1437.03, "maximum": 1437.03, "gross_charge": 6843.0, "discounted_cash": 5132.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1437.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT I-AORT PERCUT DEVICE", "code_information": [{"code": "33967", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5131.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 273.78, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 273.78, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 273.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 273.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 273.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT INTRACORPOREAL DEVICE", "code_information": [{"code": "33979", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2426.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2426.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2426.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2426.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2426.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT INTRAUTERINE DEVICE", "code_information": [{"code": "58300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7875.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 85.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 85.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 85.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 85.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 85.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT LENS PROSTHESIS", "code_information": [{"code": "66985", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13866.0, "estimated_discounted_cash": 16759.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12478.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13866.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT LEVONORGESTREL IUS", "code_information": [{"code": "S4981", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1399.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1399.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1399.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1399.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1399.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1876.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1876.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1876.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1876.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1876.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT MESH/PELVIC FLR ADDON", "code_information": [{"code": "57267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT MULTI-COMP PENIS PROS", "code_information": [{"code": "54405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 33590.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NASAL SEPTAL BUTTON", "code_information": [{"code": "30220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE BONE CAVITY", "code_information": [{"code": "36680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE CATH BOWEL", "code_information": [{"code": "44015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 135.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 135.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 135.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 135.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 135.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5908.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PACING LEAD & CONNECT", "code_information": [{"code": "33224", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16765.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16765.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16765.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16765.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16765.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PALATE IMPLANTS", "code_information": [{"code": "C9727", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PELV FIXATION DEVICE", "code_information": [{"code": "22848", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 366.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 366.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 366.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 366.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 366.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PESSARY/OTHER DEVICE", "code_information": [{"code": "57160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PHALANGEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2941.47, "maximum": 2941.47, "gross_charge": 14007.0, "discounted_cash": 10505.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2941.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7008.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PLEURAL CATH", "code_information": [{"code": "32550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1372.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1372.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1372.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1372.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1372.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PROST URETHRAL STENT", "code_information": [{"code": "53855", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN DUAL LEADS", "code_information": [{"code": "33213", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6912.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6912.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6912.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6912.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6912.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN MULT LEADS", "code_information": [{"code": "33221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN SNGL LEAD", "code_information": [{"code": "33212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6350.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6350.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6350.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6350.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6350.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SELF-CONTD PROSTHESIS", "code_information": [{"code": "54401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 32947.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SEMI-RIGID PROSTHESIS", "code_information": [{"code": "54400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8649.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2245.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2245.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2245.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2245.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2245.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2856.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2856.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2856.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2856.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2856.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22843", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 815.26, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 815.26, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 815.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 815.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 815.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22844", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1005.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1005.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1005.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1005.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1005.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1844.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1844.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1844.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1844.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1844.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22846", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 765.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 765.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 765.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 765.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 765.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22847", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 841.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 841.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 841.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 841.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 841.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE INFUSION DEVICE", "code_information": [{"code": "62360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SUBQ EXTEN TO IP CATH", "code_information": [{"code": "49435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 113.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 113.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 113.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 113.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 113.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TANDEM CUFF", "code_information": [{"code": "53444", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TEMP BLADDER CATH", "code_information": [{"code": "51702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1245.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT THORACOSTMY TUBE", "code_information": [{"code": "4917772", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3212.0, "discounted_cash": 2409.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT THORACOSTMY TUBE", "code_information": [{"code": "5057576", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4338.0, "discounted_cash": 3253.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1581.72, "maximum": 1581.72, "gross_charge": 7532.0, "discounted_cash": 5649.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1581.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL ANY DJO CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1506.12, "maximum": 1506.12, "gross_charge": 7172.0, "discounted_cash": 5379.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1506.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TISSUE EXPANDER(S)", "code_information": [{"code": "11960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH PERC", "code_information": [{"code": "49418", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH W/PORT", "code_information": [{"code": "49419", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12719.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 20574.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36566", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4811.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4811.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4811.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4811.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4811.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT URETERAL SUPPORT", "code_information": [{"code": "50605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 948.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 948.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 948.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 948.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 948.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT URO/VES NCK SPHINCTER", "code_information": [{"code": "53445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT UTERI TANDEM/OVOIDS", "code_information": [{"code": "57155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 271.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT/BEAR PLY PLYX3 GLOB CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1506.12, "maximum": 1506.12, "gross_charge": 7172.0, "discounted_cash": 5379.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1506.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT/PLACE HEART CATHETER", "code_information": [{"code": "93503", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 105.35, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 105.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 105.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 105.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 105.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 50.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 50.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 50.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 50.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 50.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 103.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 103.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 103.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 103.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 103.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 71.33, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 71.33, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 71.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 71.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 71.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION DRUG DLVR IMPLANT", "code_information": [{"code": "11981", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1327.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA(S)", "code_information": [{"code": "36823", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1280.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1280.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1280.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1280.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1280.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36481", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 368.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 368.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 368.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 368.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 368.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 186.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 186.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 186.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 186.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 186.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CHEST TUBE", "code_information": [{"code": "32551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4964.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 178.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 178.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 178.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 178.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 178.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF INFUSION PUMP", "code_information": [{"code": "36260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF IRIS PROSTHESIS", "code_information": [{"code": "616T", "type": "CPT"}], "standard_charges": [{"minimum": 12252.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF LEFT HEART VENT", "code_information": [{"code": "33988", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION PALATE PROSTHESIS", "code_information": [{"code": "42281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION SS DFB ELECTRODE", "code_information": [{"code": "572T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSIT E ADD PRB CMP ASST", "code_information": [{"code": "88373", "type": "CPT"}, {"code": "7270096", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 306.78, "gross_charge": 541.0, "discounted_cash": 405.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 306.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSIT MLTIPLX STAIN CMPT", "code_information": [{"code": "88374", "type": "CPT"}, {"code": "7270097", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1320.46, "gross_charge": 1616.0, "discounted_cash": 1212.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1320.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU 1ST PRB MANUAL", "code_information": [{"code": "88368", "type": "CPT"}, {"code": "4308368", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 348.58, "gross_charge": 471.0, "discounted_cash": 353.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 348.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 221.24, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 221.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 221.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 221.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 221.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU ADD PROBE MANUAL", "code_information": [{"code": "88369", "type": "CPT"}, {"code": "7270095", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 417.12, "gross_charge": 541.0, "discounted_cash": 405.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 417.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 85.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 85.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU EA ADD SNGL PROBE", "code_information": [{"code": "88364", "type": "CPT"}, {"code": "7270091", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 514.18, "gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 514.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 109.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 109.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION (FISH)", "code_information": [{"code": "88366", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1001.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1001.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION AUTO", "code_information": [{"code": "88367", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 540.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 540.86, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 259.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 259.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 259.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 259.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 259.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ ANT SGM AQ DRG DEV 1+", "code_information": [{"code": "671T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV 1ST", "code_information": [{"code": "449T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV EACH", "code_information": [{"code": "450T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRG DEV IO RSVR", "code_information": [{"code": "474T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BIOMECHANICAL DEVICE", "code_information": [{"code": "22853", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8649.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BIOMECHANICAL DEVICE", "code_information": [{"code": "22854", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BIOMECHANICAL DEVICE", "code_information": [{"code": "22859", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BIOPROSTC VLV FEM VN", "code_information": [{"code": "744T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BREAST IMPLT SM D MAST", "code_information": [{"code": "19340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 24201.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ GTUBE PERQ MAG GASTRPXY", "code_information": [{"code": "647T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "446T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH SEC IO LENS", "code_information": [{"code": "618T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH W/RMVL&INSJ", "code_information": [{"code": "617T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ OCULAR TELESCOPE PROSTH", "code_information": [{"code": "308T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTERIAL", "code_information": [{"code": "33990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTL&VEN", "code_information": [{"code": "33991", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD R HRT VENOUS", "code_information": [{"code": "33995", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM SYS", "code_information": [{"code": "33276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33277", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PICC 5 YR+ W/O IMAGING", "code_information": [{"code": "36569", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6937.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PICC <5 YR W/O IMAGING", "code_information": [{"code": "36568", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I 5 YR+", "code_information": [{"code": "36573", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13866.0, "estimated_discounted_cash": 9192.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12478.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13866.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I <5 YR", "code_information": [{"code": "36572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ RX ELUT IMPLT LAC CANAL", "code_information": [{"code": "68841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ SINUS TARSI IMPLANT", "code_information": [{"code": "335T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22867", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22868", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/O DCMPRN", "code_information": [{"code": "22869", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/O DCMPRN", "code_information": [{"code": "22870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 25172.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ IMPLTBL DFB ELCTRD", "code_information": [{"code": "33271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV BOTH COMPNT PG", "code_information": [{"code": "517T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV COMPL SYS", "code_information": [{"code": "515T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV ELTRD ONLY", "code_information": [{"code": "516T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ ATR ELT", "code_information": [{"code": "410T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ PLS GN", "code_information": [{"code": "409T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ VNT ELT", "code_information": [{"code": "411T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CARDIAC MODULJ SYS", "code_information": [{"code": "408T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT BRST IMPLT SEP D", "code_information": [{"code": "19342", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 19138.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT COMPL IIMS", "code_information": [{"code": "525T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT DEFIB W/LEAD(S)", "code_information": [{"code": "33249", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 81028.0, "estimated_discounted_cash": 191773.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 81028.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26786.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26786.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26786.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26786.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26786.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT ICDS SS ELTRD", "code_information": [{"code": "571T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS ELTRD ONLY", "code_information": [{"code": "526T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS IMPLT MNTR", "code_information": [{"code": "527T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PG ONLY ISDSS", "code_information": [{"code": "680T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PRQ RA SAC NSTIM", "code_information": [{"code": "786T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSR TNL VAD 2STS W PRT", "code_information": [{"code": "4916566", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 39965.0, "discounted_cash": 29973.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSR TNL VAD 2STS WO PRT", "code_information": [{"code": "4916565", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12026.0, "discounted_cash": 9019.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT A & V PM W/L VENT LEAD", "code_information": [{"code": "C7539", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT AICD W/EXIS LD", "code_information": [{"code": "4613240", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 142049.0, "discounted_cash": 106536.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT ATRIL PM W/L VENT LEAD", "code_information": [{"code": "C7537", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT BEARNG TIB RP AESCULP CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 958.23, "maximum": 958.23, "gross_charge": 4563.0, "discounted_cash": 3422.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 958.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT BILI DRAIN EXT", "code_information": [{"code": "4917760", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11362.0, "discounted_cash": 8521.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT BILI DRAIN INT/EXT", "code_information": [{"code": "4917534", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13963.0, "discounted_cash": 10472.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT CVAD W PORT<5 YRS", "code_information": [{"code": "4916570", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10636.0, "discounted_cash": 7977.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT CVAD W PRT 5YRS>", "code_information": [{"code": "4916571", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7639.0, "discounted_cash": 5729.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT HEART PM ATRIAL & VENT", "code_information": [{"code": "33208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "estimated_discounted_cash": 56338.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8772.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8772.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8772.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8772.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8772.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT LD VEN LTVENT PREV", "code_information": [{"code": "4613221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 41506.0, "discounted_cash": 31129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT NON-TUNNL CV CTH<5", "code_information": [{"code": "4916555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10636.0, "discounted_cash": 7977.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT NONTUNNL CV CTH 5>", "code_information": [{"code": "4916556", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5919.0, "discounted_cash": 4439.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PERM INTRAPTNL CTH", "code_information": [{"code": "4919421", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9010.0, "discounted_cash": 6757.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC NO PRT/PMP<5 NO IMG", "code_information": [{"code": "4916568", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5919.0, "discounted_cash": 4439.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC NO PRT/PMP>5 NO IMG", "code_information": [{"code": "4546569", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7560.0, "discounted_cash": 5670.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC NO PRT/PMP>5 NO IMG", "code_information": [{"code": "4616569", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7355.0, "discounted_cash": 5516.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC NO PRT/PMP>5 NO IMG", "code_information": [{"code": "4906569", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8816.0, "discounted_cash": 6612.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC NO PRT/PMP>5 NO IMG", "code_information": [{"code": "4916569", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8816.0, "discounted_cash": 6612.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC NO PRT/PMP>5 NO IMG", "code_information": [{"code": "6296510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8816.0, "discounted_cash": 6612.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC W/IMG 5+YR", "code_information": [{"code": "4546573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9070.0, "discounted_cash": 6802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC W/IMG 5+YR", "code_information": [{"code": "4616573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8598.0, "discounted_cash": 6448.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC W/IMG 5+YR", "code_information": [{"code": "4906573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10019.0, "discounted_cash": 7514.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC W/IMG 5+YR", "code_information": [{"code": "4916573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10019.0, "discounted_cash": 7514.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC W/IMG 5+YR", "code_information": [{"code": "6296573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7560.0, "discounted_cash": 5670.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN MULT LDS", "code_information": [{"code": "4613217", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 45950.0, "discounted_cash": 34462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/DUAL LEADS", "code_information": [{"code": "33230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/MULT LEADS", "code_information": [{"code": "33231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/SINGL LEAD", "code_information": [{"code": "33240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 81028.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 81028.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22075.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22075.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22075.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22075.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22075.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "4613271", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 26864.0, "discounted_cash": 20148.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TEMP BLADDER CATH", "code_information": [{"code": "4911702", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 485.0, "discounted_cash": 363.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TEMP BLADDER CATH", "code_information": [{"code": "5201702", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 978.0, "discounted_cash": 733.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TNL CV CTH5>WO PMP", "code_information": [{"code": "4916558", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4651.0, "discounted_cash": 3488.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TNL CV CTH<5WO PMP", "code_information": [{"code": "4916557", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10636.0, "discounted_cash": 7977.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TRAN ELCTRD DUAL", "code_information": [{"code": "4612507", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 26442.0, "discounted_cash": 19831.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TRAN ELCTRD SNGL", "code_information": [{"code": "4612510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20357.0, "discounted_cash": 15267.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TUNLD PLEURAL CATH", "code_information": [{"code": "4912019", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9265.0, "discounted_cash": 6948.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TUNNEL VAD W PUMP", "code_information": [{"code": "4916563", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13590.0, "discounted_cash": 10192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TUNNL VAD 5>W PORT", "code_information": [{"code": "4916561", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17163.0, "discounted_cash": 12872.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TUNNL VAD<5 W PORT", "code_information": [{"code": "4916560", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13590.0, "discounted_cash": 10192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT VENT PM W/L VENT LEAD", "code_information": [{"code": "C7538", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT/BEAR VIT E ATTUN DPY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 838.32, "maximum": 838.32, "gross_charge": 3992.0, "discounted_cash": 2994.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 838.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT/REDO NEUROSTIM 1 ARRAY", "code_information": [{"code": "61885", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT/REPL TEMP PM LEAD", "code_information": [{"code": "4613595", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17632.0, "discounted_cash": 13224.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT/RPL SQ DEFIB W/ELE", "code_information": [{"code": "4610319", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 238352.0, "discounted_cash": 178764.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT/RPLC AICD & LDS", "code_information": [{"code": "4613249", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 127496.0, "discounted_cash": 95622.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTALL SPINAL SHUNT", "code_information": [{"code": "63740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 874.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 874.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 874.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 874.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 874.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSTALL SPINAL SHUNT", "code_information": [{"code": "63741", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSTILL ADSTILADRIN, TX DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9029", "type": "HCPCS"}], "standard_charges": [{"minimum": 57008.05, "maximum": 63342.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 57008.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 63342.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 63342.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 63342.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 63342.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTILL PHARM RENAL PELVIS", "code_information": [{"code": "C9789", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSTL AGNT VIA CHEST TBE INIT", "code_information": [{"code": "4910015", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5793.0, "discounted_cash": 4344.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTL AGNT VIA CHEST TBE SUBQ", "code_information": [{"code": "4910016", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5793.0, "discounted_cash": 4344.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTLJ FECAL MICROBIOTA SSP", "code_information": [{"code": "780T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSTLL RX AGNT INTO RNAL TUB", "code_information": [{"code": "50391", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSULIN ANTIBODIES", "code_information": [{"code": "86337", "type": "CPT"}, {"code": "7256042", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 109.21, "gross_charge": 123.0, "discounted_cash": 92.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 109.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN CARTRIDGE 150 U", "code_information": [{"code": "S5565", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN CARTRIDGE 300 U", "code_information": [{"code": "S5566", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN DISPOS PEN 1.5 ML", "code_information": [{"code": "S5570", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN DISPOS PEN 3 ML", "code_information": [{"code": "S5571", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN FREE", "code_information": [{"code": "83527", "type": "CPT"}, {"code": "7253527", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.03, "gross_charge": 238.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.68, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN GF BINDING PROTEIN/4", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "7253547", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.03, "gross_charge": 322.0, "discounted_cash": 241.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN GF BINDING PROTEIN/5", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "7253592", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.03, "gross_charge": 322.0, "discounted_cash": 241.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN INTERMED 5 U", "code_information": [{"code": "S5552", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.24, "maximum": 0.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN LONG ACTING 5 U", "code_information": [{"code": "S5553", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.99, "maximum": 1.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN MOST RAPID 5 U", "code_information": [{"code": "S5551", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.37, "maximum": 0.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN PUMP INITIATION", "code_information": [{"code": "S9145", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN RAPID 5 U", "code_information": [{"code": "S5550", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.24, "maximum": 0.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN REUSE PEN 1.5 ML", "code_information": [{"code": "S5560", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN REUSE PEN 3 ML", "code_information": [{"code": "S5561", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSULIN SUPPRESSION PANEL", "code_information": [{"code": "80432", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 409.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 409.64, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 188.73, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 188.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 188.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 188.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 188.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 165.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 165.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80434", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 515.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 515.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 141.3, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 141.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 141.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 141.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 141.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 285.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 285.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 516.11, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 516.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 143.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 103.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 103.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN TOTAL", "code_information": [{"code": "83525", "type": "CPT"}, {"code": "7253525", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.33, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INT HRHC LIG 1 HROID W/O IMG", "code_information": [{"code": "46945", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 148.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 148.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 148.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 148.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 148.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INT HRHC LIG 2+HROID W/O IMG", "code_information": [{"code": "46946", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INT HRHC TRANAL DARTLZJ 2+", "code_information": [{"code": "46948", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2INX2IN 25CM PER SQ CM", "code_information": [{"code": "Q4108", "type": "HCPCS"}, {"code": "8241495", "type": "CDM"}], "standard_charges": [{"minimum": 1318.59, "maximum": 1318.59, "gross_charge": 6279.0, "discounted_cash": 4709.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1318.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 4INX5IN 120CM PR SQ CM", "code_information": [{"code": "Q4108", "type": "HCPCS"}, {"code": "8241496", "type": "CDM"}], "standard_charges": [{"minimum": 95.97, "maximum": 95.97, "gross_charge": 457.0, "discounted_cash": 342.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 95.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA BMWD", "code_information": [{"code": "Q4104", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTEGRA DRT OR OMNIGRAFT", "code_information": [{"code": "Q4105", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTEGRA MESHED BIL WOUND MAT", "code_information": [{"code": "C9363", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTEGRATED KERATOPROSTHESIS", "code_information": [{"code": "C1818", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTENS BEHAVE THER CARDIO DX", "code_information": [{"code": "G0446", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTENS CARDIAC REHAB NO EXER", "code_information": [{"code": "G0423", "type": "HCPCS"}], "standard_charges": [{"minimum": 160.92, "maximum": 184.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 165.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 160.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 184.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 184.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 184.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTENS CARDIAC REHAB W/EXERC", "code_information": [{"code": "G0422", "type": "HCPCS"}], "standard_charges": [{"minimum": 160.92, "maximum": 184.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 165.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 160.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 184.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 184.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 184.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "1990062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7259.0, "discounted_cash": 5444.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "2000062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7259.0, "discounted_cash": 5444.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "2120062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7259.0, "discounted_cash": 5444.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "2150062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7259.0, "discounted_cash": 5444.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "2160062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7259.0, "discounted_cash": 5444.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "2350062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7259.0, "discounted_cash": 5444.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE UNIT", "code_information": [{"code": "1990022", "type": "CDM"}, {"code": "200", "type": "RC"}], "standard_charges": [{"gross_charge": 8348.0, "discounted_cash": 6261.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE UNIT", "code_information": [{"code": "2000022", "type": "CDM"}, {"code": "200", "type": "RC"}], "standard_charges": [{"gross_charge": 8348.0, "discounted_cash": 6261.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE UNIT", "code_information": [{"code": "2120022", "type": "CDM"}, {"code": "200", "type": "RC"}], "standard_charges": [{"gross_charge": 8348.0, "discounted_cash": 6261.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE OUTPATIENT PSYCHIA", "code_information": [{"code": "S9480", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERACTIVE GRP PSYC PHP/IOP", "code_information": [{"code": "G0411", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERCALARY ALGRFT COMPL", "code_information": [{"code": "20934", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERDENTAL FIXATION", "code_information": [{"code": "21110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERDENTAL WIRING", "code_information": [{"code": "21497", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERDISCAL PERQ ASPIR DX", "code_information": [{"code": "62267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERFERENTIAL STIM 2 CHAN", "code_information": [{"code": "S8130", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERENTIAL STIM 4 CHAN", "code_information": [{"code": "S8131", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFA-2A INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9213", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.48, "maximum": 40.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 40.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 40.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFA-N3 INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9215", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.9, "maximum": 34.33, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 34.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 34.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 34.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFACON-1 INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9212", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.9, "maximum": 6.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON BETA-1A INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1826", "type": "HCPCS"}], "standard_charges": [{"minimum": 2215.59, "maximum": 2461.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2215.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2461.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2461.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2461.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2461.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON BETA-1B / .25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1830", "type": "HCPCS"}], "standard_charges": [{"minimum": 729.04, "maximum": 810.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 729.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 810.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 810.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 810.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 810.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON GAMMA 1-B INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9216", "type": "HCPCS"}], "standard_charges": [{"minimum": 8679.6, "maximum": 9644.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8679.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9644.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9644.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9644.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9644.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERIM LABOR FACILITY GLOBA", "code_information": [{"code": "S4005", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERLEUKIN 6", "code_information": [{"code": "83529", "type": "CPT"}, {"code": "7250244", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.27, "maximum": 17.27, "gross_charge": 108.0, "discounted_cash": 81.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERMEDIATE VISUAL FIELD XM", "code_information": [{"code": "92082", "type": "CPT"}], "standard_charges": [{"minimum": 74.08, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 74.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 74.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 74.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 74.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 74.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERNAL NERVE REVISION", "code_information": [{"code": "64727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERRO EVAL CARDIAC MODULJ", "code_information": [{"code": "418T", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ICPMS IP", "code_information": [{"code": "93290", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL IIMS IP", "code_information": [{"code": "529T", "type": "CPT"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL SCRMS IP", "code_information": [{"code": "93291", "type": "CPT"}], "standard_charges": [{"minimum": 23.38, "maximum": 26.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 26.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 26.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 26.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL WCS IP", "code_information": [{"code": "521T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEVICE EVAL HEART", "code_information": [{"code": "93289", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG EVL PM/LDLS PM IP", "code_information": [{"code": "93288", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATE SUBQ DEFIB", "code_information": [{"code": "93261", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATION VAD IN PERSON", "code_information": [{"code": "93750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 183.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 164.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 160.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTIT RADELM CMPLEX", "code_information": [{"code": "77778", "type": "CPT"}, {"code": "5107778", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1220.92, "gross_charge": 4895.0, "discounted_cash": 3671.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1027.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 755.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 869.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1099.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1220.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1220.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1220.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1220.92, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 869.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 869.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 869.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 869.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [{"code": "197", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6225.45, "maximum": 39709.39, "estimated_discounted_cash": 35254.4, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11923.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30045.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16488.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8926.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31615.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17349.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9392.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12546.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18320.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13248.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9918.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33384.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13248.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33384.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9918.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18320.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33384.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18320.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13248.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9918.66, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10389.66, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 24059.03, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7292.59, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6225.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31512.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39709.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [{"code": "196", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5327.9, "maximum": 78958.56, "estimated_discounted_cash": 73278.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6979.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16079.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 28917.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10324.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10863.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30427.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16919.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7344.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11471.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17865.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32130.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7755.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7755.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17865.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32130.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11471.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7755.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11471.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17865.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32130.98, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5327.9, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9606.91, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6901.22, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 19853.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 62658.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 78958.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC", "code_information": [{"code": "198", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4319.46, "maximum": 29965.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8853.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24269.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13959.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10579.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25537.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11132.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9316.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14688.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15510.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9837.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 26966.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11755.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15510.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 26966.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9837.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11755.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 26966.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15510.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9837.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11755.44, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5155.69, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4319.46, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 18415.42, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7228.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23779.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29965.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERTHORACOSCPLR AMPUTATION", "code_information": [{"code": "23900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1307.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1307.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1307.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1307.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1307.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERV REQ FOR LEAK", "code_information": [{"code": "G9306", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTESTINAL STRICTUROPLASTY", "code_information": [{"code": "44615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 983.6, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 983.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 983.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 983.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 983.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTESTINE IMAGING", "code_information": [{"code": "78290", "type": "CPT"}, {"code": "5208290", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 650.79, "gross_charge": 3099.0, "discounted_cash": 2324.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 650.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 550.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 300.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 300.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 300.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 300.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 300.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLANT LIVE", "code_information": [{"code": "44136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLNT CADAVER", "code_information": [{"code": "44135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 12.6-20 CM", "code_information": [{"code": "12055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 2.5 CM/<", "code_information": [{"code": "12051", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 2.6-5.0 CM", "code_information": [{"code": "12052", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 20.1-30.0", "code_information": [{"code": "12056", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 5.1-7.5 CM", "code_information": [{"code": "12053", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 7.6-12.5CM", "code_information": [{"code": "12054", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM >30.0 CM", "code_information": [{"code": "12057", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT 2.5CM/<", "code_information": [{"code": "12041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT >30.0CM", "code_information": [{"code": "12047", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT12.6-20", "code_information": [{"code": "12045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT2.6-7.5", "code_information": [{"code": "12042", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT20.1-30", "code_information": [{"code": "12046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT7.6-12.5", "code_information": [{"code": "12044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 12.6-20", "code_information": [{"code": "12035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 2.5 CM/<", "code_information": [{"code": "12031", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2084.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 2.6-7.5", "code_information": [{"code": "12032", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6127.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 20.1-30", "code_information": [{"code": "12036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/TR/EXT 7.6-12.5", "code_information": [{"code": "12034", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/TR/EXT >30.0 CM", "code_information": [{"code": "12037", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTR ACCUSTICK II ROMRKR", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8247240", "type": "CDM"}], "standard_charges": [{"minimum": 51.87, "maximum": 51.87, "gross_charge": 247.0, "discounted_cash": 185.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 51.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTR HEMOSTASIS FASTCATH", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8247250", "type": "CDM"}], "standard_charges": [{"minimum": 19.74, "maximum": 19.74, "gross_charge": 94.0, "discounted_cash": 70.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 19.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTR SHTH CATH AVANTI", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "4032850", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 11.55, "maximum": 11.55, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 11.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTR SHTH INPUT-TS", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174944", "type": "CDM"}], "standard_charges": [{"minimum": 241.5, "maximum": 241.5, "gross_charge": 1150.0, "discounted_cash": 862.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 241.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTR SHTH PERIPH PINNACL", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8241506", "type": "CDM"}], "standard_charges": [{"minimum": 1060.92, "maximum": 1060.92, "gross_charge": 5052.0, "discounted_cash": 3789.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1060.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTR SHTH PINNACLE R/O", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "4023190", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 712.11, "maximum": 712.11, "gross_charge": 3391.0, "discounted_cash": 2543.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 712.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTR SHTH SUPER", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8241503", "type": "CDM"}], "standard_charges": [{"minimum": 292.32, "maximum": 292.32, "gross_charge": 1392.0, "discounted_cash": 1044.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 292.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRA-ARTERIAL RECORDING", "code_information": [{"code": "93602", "type": "CPT"}, {"code": "4613625", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "gross_charge": 4229.0, "discounted_cash": 3171.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10612.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7146.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6942.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL PACING", "code_information": [{"code": "93610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7146.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6942.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAABDOMINAL PRESSURE TEST", "code_information": [{"code": "51797", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACARD ABL ARRHY", "code_information": [{"code": "93655", "type": "CPT"}, {"code": "4613659", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32403.55, "gross_charge": 34109.0, "discounted_cash": 25581.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 7162.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 8937.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 32403.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 32403.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12586.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 25581.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 25581.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACARD ECHO", "code_information": [{"code": "93662", "type": "CPT"}, {"code": "4613662", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13736.05, "gross_charge": 14459.0, "discounted_cash": 10844.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3036.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10612.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 13736.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 13736.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5335.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 10844.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 10844.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRAN ANGIOPLSTY W/STENT", "code_information": [{"code": "61635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1367.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1367.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1367.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1367.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1367.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL ANGIOPLASTY", "code_information": [{"code": "61630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1249.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1249.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1249.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1249.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1249.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [{"code": "65", "type": "MS-DRG"}], "standard_charges": [{"minimum": 33543.98, "maximum": 42269.94, "estimated_discounted_cash": 78202.07, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33543.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42269.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [{"code": "64", "type": "MS-DRG"}], "standard_charges": [{"minimum": 66769.22, "maximum": 84138.23, "estimated_discounted_cash": 93375.14, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 66769.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 84138.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC", "code_information": [{"code": "66", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22723.45, "maximum": 28634.61, "estimated_discounted_cash": 60853.98, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22723.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28634.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL LIMITED STUDY", "code_information": [{"code": "93888", "type": "CPT"}], "standard_charges": [{"minimum": 153.23, "maximum": 241.11, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 241.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 157.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 153.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 241.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 241.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 241.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 241.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC", "code_information": [{"code": "21", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21382.03, "maximum": 221487.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 109280.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 70043.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36779.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46817.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 73701.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 49262.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 114988.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 38700.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 121424.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 77826.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 40866.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52019.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52019.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 121424.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40866.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 77826.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52019.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 77826.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 121424.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40866.4, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 21382.03, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 81768.34, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 42898.44, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 27041.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 175764.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 221487.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC", "code_information": [{"code": "20", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20886.29, "maximum": 329222.72, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 64489.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 100819.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 39234.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 47132.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 41283.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 106085.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 67858.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 49594.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 71656.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 112022.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52369.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 43593.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 43593.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 71656.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 112022.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52369.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 112022.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52369.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 43593.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 71656.09, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 38198.04, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 66275.17, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 20886.29, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 25287.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 261259.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 329222.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "22", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14602.14, "maximum": 132939.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29738.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25075.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 41350.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83509.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 87871.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31291.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26384.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43510.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33042.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27861.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 45945.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 92789.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 92789.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27861.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 45945.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33042.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 92789.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27861.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 45945.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33042.96, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 30928.94, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 19135.55, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 14602.14, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 69095.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 105496.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 132939.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2131.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2131.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2131.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2131.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2131.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61682", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4013.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4013.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4013.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4013.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4013.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61684", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2700.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2700.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2700.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2700.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2700.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61686", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4300.37, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4300.37, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4300.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4300.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4300.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2038.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2038.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2038.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2038.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2038.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61692", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3454.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3454.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3454.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3454.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3454.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAFRACTION TRACK MOTION", "code_information": [{"code": "G6017", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 200.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 180.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 200.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 200.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 200.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 200.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRALUMINL DILATN ESOPH", "code_information": [{"code": "74360", "type": "CPT"}, {"code": "4904361", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 552.3, "gross_charge": 2630.0, "discounted_cash": 1972.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRANASAL BIOPSY", "code_information": [{"code": "30100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 83.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 83.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 83.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 83.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 83.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRANASAL RECONSTRUCTION", "code_information": [{"code": "30620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR FOMIVIRSEN NA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1452", "type": "HCPCS"}], "standard_charges": [{"minimum": 190.8, "maximum": 212.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 212.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 212.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 212.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 212.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITH CC/MCC", "code_information": [{"code": "116", "type": "MS-DRG"}], "standard_charges": [{"minimum": 60032.54, "maximum": 75649.1, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 60032.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 75649.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "117", "type": "MS-DRG"}], "standard_charges": [{"minimum": 36020.85, "maximum": 45391.13, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 36020.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45391.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOP COLON LAVAGE ADD-ON", "code_information": [{"code": "44701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 158.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 158.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 158.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 158.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 158.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOP HIPEC PX 1ST 60 MIN", "code_information": [{"code": "96547", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOP OCT BREAST CAVITY", "code_information": [{"code": "353T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP OCT BRST/NODE SPEC", "code_information": [{"code": "351T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAUT COPPER CONTRACEPTIVE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7300", "type": "HCPCS"}], "standard_charges": [{"minimum": 1167.93, "maximum": 1297.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1167.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1297.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1297.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1297.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1297.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAUTERINE TRANSFUSION FTL", "code_information": [{"code": "36460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 341.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 341.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 341.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 341.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 341.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAVENTRICULAR PACING", "code_information": [{"code": "93612", "type": "CPT"}, {"code": "4613612", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "gross_charge": 4229.0, "discounted_cash": 3171.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7146.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6942.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7939.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAVERTEBRAL FX AUG IMPL", "code_information": [{"code": "C1062", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRCRD EP 3DMAP", "code_information": [{"code": "93613", "type": "CPT"}, {"code": "4613613", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "gross_charge": 25842.0, "discounted_cash": 19381.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10612.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 402.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 402.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 402.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 402.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 402.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRINSIC FACTOR ANTIBDY", "code_information": [{"code": "86340", "type": "CPT"}, {"code": "7255536", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.87, "gross_charge": 113.0, "discounted_cash": 84.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRM OPH EXAM EST PATIENT", "code_information": [{"code": "92012", "type": "CPT"}], "standard_charges": [{"minimum": 78.5, "maximum": 180.44, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 78.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 162.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 157.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 78.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 78.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 78.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 78.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRM OPH EXAM NEW PATIENT", "code_information": [{"code": "92002", "type": "CPT"}], "standard_charges": [{"minimum": 74.37, "maximum": 180.44, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 74.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 162.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 157.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 74.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 74.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 74.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 74.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36903", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO CATH SHTH STD", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174932", "type": "CDM"}], "standard_charges": [{"minimum": 1078.98, "maximum": 1078.98, "gross_charge": 5138.0, "discounted_cash": 3853.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1078.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO COOK CHECKFLO LG", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8241501", "type": "CDM"}], "standard_charges": [{"minimum": 102.48, "maximum": 102.48, "gross_charge": 488.0, "discounted_cash": 366.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 102.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO COOK CHECKFLO XLG", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8241502", "type": "CDM"}], "standard_charges": [{"minimum": 397.32, "maximum": 397.32, "gross_charge": 1892.0, "discounted_cash": 1419.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 397.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO FLEXOR CHECKFLO", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8241509", "type": "CDM"}], "standard_charges": [{"minimum": 51.24, "maximum": 51.24, "gross_charge": 244.0, "discounted_cash": 183.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 51.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO GASTROINTESTINAL TUBE", "code_information": [{"code": "44500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO MIX SALINE&AIR F/SSG", "code_information": [{"code": "568T", "type": "CPT"}], "standard_charges": [{"minimum": 12252.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO NDL DIAL-CIRC+S&I", "code_information": [{"code": "4616901", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3217.0, "discounted_cash": 2412.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO NDL DIAL-CIRC+S&I", "code_information": [{"code": "4916901", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1336.0, "discounted_cash": 1002.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO NDL ICATH UPR/LXTR ART", "code_information": [{"code": "36140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO PEEL AWAY", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174943", "type": "CDM"}], "standard_charges": [{"minimum": 53.13, "maximum": 53.13, "gross_charge": 253.0, "discounted_cash": 189.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO SHEATH PRELUDE", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174942", "type": "CDM"}], "standard_charges": [{"minimum": 22.26, "maximum": 22.26, "gross_charge": 106.0, "discounted_cash": 79.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 22.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO SHTH CATH BRITE TP", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174945", "type": "CDM"}], "standard_charges": [{"minimum": 53.13, "maximum": 53.13, "gross_charge": 253.0, "discounted_cash": 189.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO SHTH COR PINNALCE", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8182688", "type": "CDM"}], "standard_charges": [{"minimum": 93.24, "maximum": 93.24, "gross_charge": 444.0, "discounted_cash": 333.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 93.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO SHTH COR PINNCL GW", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8182689", "type": "CDM"}], "standard_charges": [{"minimum": 24.36, "maximum": 24.36, "gross_charge": 116.0, "discounted_cash": 87.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 24.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO SHTH GLIDE", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "4032851", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 118.44, "maximum": 118.44, "gross_charge": 564.0, "discounted_cash": 423.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 118.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO SHTH STEERABL", "code_information": [{"code": "C1766", "type": "HCPCS"}, {"code": "8174939", "type": "CDM"}], "standard_charges": [{"minimum": 1078.98, "maximum": 1078.98, "gross_charge": 5138.0, "discounted_cash": 3853.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1078.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO TRANSFEMORAL BLN", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174947", "type": "CDM"}], "standard_charges": [{"minimum": 61.95, "maximum": 61.95, "gross_charge": 295.0, "discounted_cash": 221.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 61.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO WINDPIPE WIRE/TUBE", "code_information": [{"code": "31730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO/SHEATH, LASER", "code_information": [{"code": "C2629", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTROD SHTH SPLITTABL W/SDPRT", "code_information": [{"code": "C1892", "type": "HCPCS"}, {"code": "8174937", "type": "CDM"}], "standard_charges": [{"minimum": 201.39, "maximum": 201.39, "gross_charge": 959.0, "discounted_cash": 719.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 201.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRODUCER LD NSTIM", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8241511", "type": "CDM"}], "standard_charges": [{"minimum": 337.89, "maximum": 337.89, "gross_charge": 1609.0, "discounted_cash": 1206.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 337.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRVASC US NONCORONARY 1ST", "code_information": [{"code": "37252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRVASC US NONCORONARY ADDL", "code_information": [{"code": "37253", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTUBATION", "code_information": [{"code": "3110210", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1819.0, "discounted_cash": 1364.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTUBATION", "code_information": [{"code": "5500205", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1941.0, "discounted_cash": 1455.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM INIT", "code_information": [{"code": "95980", "type": "CPT"}], "standard_charges": [{"minimum": 40.92, "maximum": 40.92, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM SUBSQ", "code_information": [{"code": "95981", "type": "CPT"}], "standard_charges": [{"minimum": 31.09, "maximum": 31.09, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO GA N-STIM SUBSQ W/REPROG", "code_information": [{"code": "95982", "type": "CPT"}], "standard_charges": [{"minimum": 45.32, "maximum": 45.32, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.32, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO MAP OF SENT LYMPH NODE", "code_information": [{"code": "38900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 13250.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVER BY ELCTRNS", "code_information": [{"code": "77425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13243.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11923.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13243.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13243.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13243.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13243.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVERY BY X-RAY", "code_information": [{"code": "77424", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13243.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE 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"facility"}]}, {"description": "IO RADIATION TX MANAGEMENT", "code_information": [{"code": "77469", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1188.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1188.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 722.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 802.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 802.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 802.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 802.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IODINE I-123 IOFLUPANE", "code_information": [{"code": "A9584", "type": "HCPCS"}], "standard_charges": [{"minimum": 2659.39, "maximum": 2954.88, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2659.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2954.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2954.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2954.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2954.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IODINE I-125 SODIUM IODIDE", "code_information": [{"code": "A9527", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.6, "maximum": 65.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 58.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IODINE/K IODIDE 30ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315349", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1604.0, "discounted_cash": 1203.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IODINE/K IODIDE 30ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315349", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1604.0, "discounted_cash": 1203.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IP HEMODIALYSIS", "code_information": [{"code": "90935", "type": "CPT"}, {"code": "5600976", "type": "CDM"}, {"code": "801", "type": "RC"}], "standard_charges": [{"minimum": 70.47, "maximum": 952.79, "gross_charge": 3732.0, "discounted_cash": 2799.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 783.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS 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"HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP HEMODIALYSIS", "code_information": [{"code": "90935", "type": "CPT"}, {"code": "5600976", "type": "CDM"}, {"code": "821", "type": "RC"}], "standard_charges": [{"minimum": 70.47, "maximum": 952.79, "gross_charge": 3732.0, "discounted_cash": 2799.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 783.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 857.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 833.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP IPD", "code_information": [{"code": "90945", "type": "CPT"}, {"code": "5600900", "type": "CDM"}, {"code": "802", "type": "RC"}], "standard_charges": [{"minimum": 73.44, "maximum": 645.12, "gross_charge": 3072.0, "discounted_cash": 2304.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 645.12, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 505.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 490.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 561.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 561.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 561.28, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CNSLTJ NEW/EST LOW 45", "code_information": [{"code": "99253", "type": "CPT"}], "standard_charges": [{"minimum": 114.86, "maximum": 114.86, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CNSLTJ NEW/EST MOD 60", "code_information": [{"code": "99254", "type": "CPT"}], "standard_charges": [{"minimum": 165.94, "maximum": 165.94, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 165.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 165.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 165.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 165.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 165.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CONSLTJ NEW/EST HI 80", "code_information": [{"code": "99255", "type": "CPT"}], "standard_charges": [{"minimum": 205.03, "maximum": 205.03, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 205.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 205.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 205.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 205.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 205.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CONSLTJ NEW/EST SF 35", "code_information": [{"code": "99252", "type": "CPT"}], "standard_charges": [{"minimum": 76.93, "maximum": 76.93, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 76.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 76.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 76.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 76.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 76.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPILIMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9228", "type": "HCPCS"}], "standard_charges": [{"minimum": 165.13, "maximum": 183.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 165.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 183.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 183.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 183.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 183.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM BROMIDE COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7645", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM BROMIDE NON-COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7644", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.35, "maximum": 0.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM17MCG12.9GMIH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5331239", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2602.0, "discounted_cash": 1951.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IPRATROPIUM17MCG12.9GMIH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5331239", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2602.0, "discounted_cash": 1951.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IRBESARTAN 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306051", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IRBESARTAN 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306051", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IRBESARTAN 75 MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306050", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IRBESARTAN 75 MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306050", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IRE ABLTJ 1+TUM ORGAN PERQ", "code_information": [{"code": "600T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRE ABLTJ 1+TUMORS OPEN", "code_information": [{"code": "601T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRON ASSAY", "code_information": [{"code": "83540", "type": "CPT"}, {"code": "4103540", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.03, "gross_charge": 162.0, "discounted_cash": 121.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.05, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRON BINDING CAPCTY", "code_information": [{"code": "83550", "type": "CPT"}, {"code": "4103550", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 44.57, "gross_charge": 113.0, "discounted_cash": 84.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 44.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.21, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRON STAIN PERIPHERAL BLOOD", "code_information": [{"code": "85536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATE VASC ACCESS DEV", "code_information": [{"code": "96523", "type": "CPT"}, {"code": "4546523", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 32.5, "maximum": 87.06, "gross_charge": 440.0, "discounted_cash": 330.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATE VASC ACCESS DEV", "code_information": [{"code": "96523", "type": "CPT"}, {"code": "4546523", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 32.5, "maximum": 87.06, "gross_charge": 440.0, "discounted_cash": 330.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATE VASC ACCESS DEV", "code_information": [{"code": "96523", "type": "CPT"}, {"code": "6926523", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 32.5, "maximum": 87.06, "gross_charge": 388.0, "discounted_cash": 291.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATE VASC ACCESS DEV", "code_information": [{"code": "96523", "type": "CPT"}, {"code": "6926523", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 32.5, "maximum": 87.06, "gross_charge": 388.0, "discounted_cash": 291.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATION MAXILLARY SINUS", "code_information": [{"code": "31000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRRIGATION OF BLADDER", "code_information": [{"code": "51700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2413.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRRIGATION SPHENOID SINUS", "code_information": [{"code": "31002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC", "code_information": [{"code": "62", "type": "MS-DRG"}], "standard_charges": [{"minimum": 58342.55, "maximum": 73519.49, "estimated_discounted_cash": 139112.19, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 58342.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 73519.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC", "code_information": [{"code": "61", "type": "MS-DRG"}], "standard_charges": [{"minimum": 91541.23, "maximum": 115354.31, "estimated_discounted_cash": 123555.16, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 91541.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 115354.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC", "code_information": [{"code": "63", "type": "MS-DRG"}], "standard_charges": [{"minimum": 46608.97, "maximum": 58733.59, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46608.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 58733.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISLAND PEDICLE FLAP GRAFT", "code_information": [{"code": "15740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISLET CELL ANTIBODY", "code_information": [{"code": "86341", "type": "CPT"}, {"code": "7256341", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 100.92, "gross_charge": 444.0, "discounted_cash": 333.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 100.92, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISLET CELL ANTIBODY/5", "code_information": [{"code": "86341", "type": "CPT"}, {"code": "7256430", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 100.92, "gross_charge": 135.0, "discounted_cash": 101.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 100.92, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISLET CELL ANTIBODY/7", "code_information": [{"code": "86341", "type": "CPT"}, {"code": "7258645", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 100.92, "gross_charge": 135.0, "discounted_cash": 101.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 100.92, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISLET CELL TISSUE TRANSPLANT", "code_information": [{"code": "S2102", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISOETHARINE NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7648", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.13, "maximum": 0.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISOETHARINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7649", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.14, "maximum": 0.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISOLATION STERILE ENVIR", "code_information": [{"code": "1990061", "type": "CDM"}, {"code": "164", "type": "RC"}], "standard_charges": [{"gross_charge": 5090.0, "discounted_cash": 3817.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOLATION STERILE ENVIR", "code_information": [{"code": "2160061", "type": "CDM"}, {"code": "164", "type": "RC"}], "standard_charges": [{"gross_charge": 5090.0, "discounted_cash": 3817.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOLATION STERILE ENVIR", "code_information": [{"code": "2310061", "type": "CDM"}, {"code": "164", "type": "RC"}], "standard_charges": [{"gross_charge": 5090.0, "discounted_cash": 3817.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOLATION- TOOTH W RUBB DAM", "code_information": [{"code": "D3910", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.67, "maximum": 132.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 119.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 115.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 132.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 132.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 132.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISONIAZID 100MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306097", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISONIAZID 100MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306097", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISONIAZID 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306100", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISONIAZID 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306100", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOPROTERENOL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7658", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.85, "maximum": 2.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISOPROTERENOL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7659", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.85, "maximum": 2.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISOSORBIDE DN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306177", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE DN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306177", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE DN 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306181", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE DN 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306181", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE DN 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306183", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE DN 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306183", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE DN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306173", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE DN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306173", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE MN 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306182", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE MN 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306182", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE MN 30MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306184", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE MN 30MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306184", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE MN 60MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306186", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSORBIDE MN 60MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306186", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOSULFAN BLUE PER1MG IJ", "code_information": [{"code": "Q9968", "type": "HCPCS"}, {"code": "5358208", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2.77, "maximum": 26.88, "gross_charge": 128.0, "discounted_cash": 96.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 26.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"Injection, clindamycin phosp", "code_information": [{"code": "S0077", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, crovalimab-akkz, 10 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1307", "type": "HCPCS"}], "standard_charges": [{"minimum": 533.82, "maximum": 593.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 533.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 593.13, "methodology": 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 50.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 56.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 56.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 56.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 56.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, donanemab-azbt, 2 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0175", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.72, "maximum": 4.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, eculizumab, 2 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1299", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.34, "maximum": 44.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 40.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 44.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 44.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 44.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 44.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, eculizumab-aagh (Epysqli), biosimilar, 2 mg", "code_information": [{"code": 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"code_information": [{"code": "Q5152", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.16, "maximum": 44.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 40.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 44.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 44.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 44.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 44.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, efbemalenograstim alfa-vuxw, 0.5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9361", "type": "HCPCS"}], "standard_charges": [{"minimum": 117.99, "maximum": 131.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 117.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 131.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 131.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 131.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 131.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, epinephrine (BPI), not therapeutically equivalent to J0165, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0166", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.95, "maximum": 1.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, epinephrine (Hospira), not therapeutically equivalent to J0165, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0167", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.28, "maximum": 1.42, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, epinephrine (adrenalin), not therapeutically equivalent to J0165, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0169", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.22, "maximum": 1.36, "estimated_discounted_cash": 21.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, epinephrine (international medication systems), not therapeutically equivalent to J0165, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0168", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.29, "maximum": 2.54, "estimated_discounted_cash": 54.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, filgrastim-txid (Nypozi), biosimilar, 1 microgram", "code_information": [{"code": "Q5148", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.53, "maximum": 0.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, foscarbidopa 0.25 mg/foslevodopa 5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7356", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.64, "maximum": 0.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, glycopyrrolate (Fresenius Kabi), not therapeutically equivalent to J1596, 0.1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1598", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.21, "maximum": 1.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, iloprost, 0.1 mcg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1749", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.14, "maximum": 5.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, imetelstat, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0870", "type": "HCPCS"}], "standard_charges": [{"minimum": 51.33, "maximum": 57.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 51.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 57.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, immune globulin (Alyglo), 500 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1552", "type": "HCPCS"}], "standard_charges": [{"minimum": 117.22, "maximum": 130.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 117.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 130.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 130.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 130.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 130.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, indigotindisulfonate sodium, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9220", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.26, "maximum": 11.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, marstacimab-hncq, 0.5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7172", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.99, "maximum": 51.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 51.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 51.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, meropenem (WG Critical Care), not therapeutically equivalent to J2185, 100 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2183", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.46, "maximum": 1.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, metronidazole", "code_information": [{"code": "S0030", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, micafungin in sodium (Baxter), not therapeutically equivalent to J2248, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2246", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.44, "maximum": 0.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, mirikizumab-mrkz, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2267", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.75, "maximum": 43.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 38.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 43.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 43.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 43.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, naloxone hydrochloride (Zimhi), 0.01 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2313", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.02, "maximum": 0.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, nivolumab, 2 mg and hyaluronidase-nvhy", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9289", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.62, "maximum": 27.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 27.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram", 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"methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "JK GNOTYP SLC14A1 EXON 9", "code_information": [{"code": "192U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOHN CUNNINGHAM ANTIBODY", "code_information": [{"code": "86711", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 73.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOINT 2 OR MORE SNGL VW", 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"plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOINT 2 OR MORE SNGL VW", "code_information": [{"code": "77077", "type": "CPT"}, {"code": "5014068", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 333.27, "gross_charge": 1587.0, "discounted_cash": 1190.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 333.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 129.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JR GNOTYP ABCG2 EXONS 2-26", "code_information": [{"code": "193U", "type": "CPT"}], "standard_charges": [{"minimum": 282.88, "maximum": 282.88, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K IODIDE 1GM/ML 30ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316107", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 310.0, "discounted_cash": 232.5, "setting": "both", "billing_class": "facility"}]}, {"description": "K IODIDE 1GM/ML 30ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316107", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 310.0, "discounted_cash": 232.5, "setting": "both", "billing_class": "facility"}]}, {"description": "K IODIDE 1GM/ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316105", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "billing_class": "facility"}]}, {"description": "K IODIDE 1GM/ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316105", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132950", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 156.66, "maximum": 156.66, "gross_charge": 746.0, "discounted_cash": 559.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 156.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132955", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 290.85, "maximum": 290.85, "gross_charge": 1385.0, "discounted_cash": 1038.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 290.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KAPPA LAMBDA LT CHN QUAN", "code_information": [{"code": "83521", "type": "CPT"}, {"code": "7253884", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.27, "maximum": 17.27, "gross_charge": 108.0, "discounted_cash": 81.0, "setting": 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{"description": "KAPPA LAMBDA LT CHN QUAN/3", "code_information": [{"code": "83521", "type": "CPT"}, {"code": "7253889", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.27, "maximum": 17.27, "gross_charge": 77.0, "discounted_cash": 57.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KCL 20MEQ PK PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316097", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KCL 20MEQ PK 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"standard_charges": [{"minimum": 0.27, "maximum": 0.3, "gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KETOROLAC PER 15MG IJ", "drug_information": {"unit": 1.0, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16093.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33649.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 104410.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11618.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16093.25, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 79007.85, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16365.93, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9933.06, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 32832.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37976.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47855.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "696", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9484.28, "maximum": 50823.5, "estimated_discounted_cash": 21109.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE 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CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50823.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13487.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17176.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13487.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25569.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50823.5, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9484.28, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 32388.76, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16051.53, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10344.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22876.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28827.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & BIOPSY", "code_information": [{"code": "50555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & BIOPSY", "code_information": [{"code": "50574", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 248.38, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 115.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 115.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 115.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 115.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 115.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY HISTOTRIPSY W/IMAGE", "code_information": [{"code": "C9790", "type": "HCPCS"}], "standard_charges": [{"minimum": 9008.0, "maximum": 9008.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAG VASC FLOW", "code_information": [{"code": "78701", "type": "CPT"}, {"code": "5208701", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 521.43, "gross_charge": 2483.0, "discounted_cash": 1862.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 521.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 511.79, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 232.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 232.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 232.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 232.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 232.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 195.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 195.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 195.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 195.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMG FLW/FNCT W/WO", "code_information": [{"code": "78709", "type": "CPT"}, {"code": "5208709", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 698.71, "gross_charge": 2105.0, "discounted_cash": 1578.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 442.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 698.71, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 374.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 374.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 374.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 374.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 374.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT", "code_information": [{"code": "652", "type": "MS-DRG"}], "standard_charges": [{"minimum": 107225.86, "maximum": 135119.05, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 107225.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 135119.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC", "code_information": [{"code": "650", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18472.82, "maximum": 196701.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 50111.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 37784.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28551.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 91040.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 37784.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 55680.31, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 24207.75, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 37038.27, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 58442.49, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 18472.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 156095.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 196701.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [{"code": "651", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11034.12, "maximum": 155046.97, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 39293.61, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 146.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 146.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 146.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 146.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 146.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 146.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY DX", "code_information": [{"code": "29870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/DRAINAGE", "code_information": [{"code": "29871", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29851", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29873", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29874", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29876", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29877", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29879", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 23233.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29881", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 21673.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29882", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 30815.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29883", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29884", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9437.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29885", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29886", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29887", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29888", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 32417.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29889", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCP HARV", "code_information": [{"code": "S2112", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE COMP 4 VW MIN", "code_information": [{"code": "73564", "type": "CPT"}, {"code": "4903570", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 196.98, "gross_charge": 938.0, "discounted_cash": 703.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 196.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 87.81, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", 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"standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE COMP 4 VW MIN", "code_information": [{"code": "73564", "type": "CPT"}, {"code": "5013570", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 196.98, "gross_charge": 938.0, "discounted_cash": 703.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 196.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 87.81, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER 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"GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [{"code": "486", "type": "MS-DRG"}], "standard_charges": [{"minimum": 69428.7, "maximum": 87489.53, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"standard_charges": [{"minimum": 52000.97, "maximum": 65528.24, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 52000.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 65528.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC", "code_information": [{"code": "488", "type": "MS-DRG"}], "standard_charges": [{"minimum": 58731.02, "maximum": 74009.01, "estimated_discounted_cash": 91258.4, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 58731.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 74009.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC", "code_information": [{"code": "489", "type": "MS-DRG"}], "standard_charges": [{"minimum": 37079.99, "maximum": 46725.8, "estimated_discounted_cash": 62292.05, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37079.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46725.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEES/BILAT AP STANDING", "code_information": [{"code": "73565", "type": "CPT"}, {"code": "4903561", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 131.25, "gross_charge": 625.0, "discounted_cash": 468.75, "setting": "both", "payers_information": 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{"description": "KYLEENA, 19.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7296", "type": "HCPCS"}], "standard_charges": [{"minimum": 1246.21, "maximum": 1384.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1246.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1384.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1384.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1384.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1384.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KYPHECTOMY 1-2 SEGMENTS", "code_information": [{"code": "22818", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2177.95, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2177.95, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2177.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2177.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2177.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KYPHECTOMY 3 OR MORE", "code_information": [{"code": "22819", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2463.8, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2463.8, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2463.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2463.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2463.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kcentra, per i.u.", "code_information": [{"code": "C9132", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L COLECTOMY/COLOPROCTOSTOMY", "code_information": [{"code": "44207", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1692.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1692.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1692.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1692.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1692.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L COLECTOMY/COLOPROCTOSTOMY", "code_information": [{"code": "44208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1851.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1851.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1851.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1851.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1851.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7523", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7524", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT CATH CHD NM/ABN NT CNJ", "code_information": [{"code": "93595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT GFT ANG W/ IVUS OR OCT", "code_information": [{"code": "C7525", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT GFT ANG W/FLOW RESRV", "code_information": [{"code": "C7526", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L SP FACET INJ+IMAG LV3+", "code_information": [{"code": "4904495", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2687.0, "discounted_cash": 2015.25, "setting": "both", "billing_class": "facility"}]}, {"description": "L SP FACET INJ+IMAG LV3+", "code_information": [{"code": "4914495", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2687.0, "discounted_cash": 2015.25, "setting": "both", "billing_class": "facility"}]}, {"description": "L SP FACET INJ+IMAG LV3+", "code_information": [{"code": "5054495", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2687.0, "discounted_cash": 2015.25, "setting": "both", "billing_class": "facility"}]}, {"description": "L SP FACET INJ+IMAG LVL1", "code_information": [{"code": "4904493", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7572.0, "discounted_cash": 5679.0, "setting": "both", "billing_class": "facility"}]}, {"description": "L SP FACET INJ+IMAG LVL1", "code_information": [{"code": "4914493", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7572.0, "discounted_cash": 5679.0, "setting": "both", "billing_class": "facility"}]}, {"description": "L SP FACET INJ+IMAG LVL1", "code_information": [{"code": "5054493", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7572.0, "discounted_cash": 5679.0, "setting": "both", "billing_class": "facility"}]}, {"description": "L SP FACET INJ+IMAG LVL2", "code_information": [{"code": "4904494", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3113.0, "discounted_cash": 2334.75, "setting": "both", "billing_class": "facility"}]}, {"description": "L SP FACET INJ+IMAG LVL2", "code_information": [{"code": "4914494", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2687.0, "discounted_cash": 2015.25, "setting": "both", "billing_class": "facility"}]}, {"description": "L SP FACET INJ+IMAG LVL2", "code_information": [{"code": "5054494", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2687.0, "discounted_cash": 2015.25, "setting": "both", "billing_class": "facility"}]}, {"description": "L VENTRIC PACING LEAD ADD-ON", "code_information": [{"code": "33225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16765.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16765.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16765.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16765.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16765.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L&D EPIDURAL", "code_information": [{"code": "3702299", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 1975.0, "discounted_cash": 1481.25, "setting": "both", "billing_class": "facility"}]}, {"description": "L&D RECOVERY ADD 15 MIN", "code_information": [{"code": "3101223", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 1089.0, "discounted_cash": 816.75, "setting": "both", "billing_class": "facility"}]}, {"description": "L&D RECOVERY INT 30 MIN", "code_information": [{"code": "3101222", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 5605.0, "discounted_cash": 4203.75, "setting": "both", "billing_class": "facility"}]}, {"description": "L&D SPEC PROC ADD 15 MIN", "code_information": [{"code": "3101203", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3648.0, "discounted_cash": 2736.0, "setting": "both", "billing_class": "facility"}]}, {"description": "L&D SPEC PROC INT 30 MIN", "code_information": [{"code": "3101202", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9099.0, "discounted_cash": 6824.25, "setting": "both", "billing_class": "facility"}]}, {"description": "L&D SURG LVL I EA 15 MIN", "code_information": [{"code": "3101215", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 222.0, "setting": "both", "billing_class": "facility"}]}, {"description": "L&D SURG LVL I INT 30 M", "code_information": [{"code": "3101214", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1623.0, "discounted_cash": 1217.25, "setting": "both", "billing_class": "facility"}]}, {"description": "L&D SURG LVL II EA 15 M", "code_information": [{"code": "3101217", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "billing_class": "facility"}]}, {"description": "L&D SURG LVL II INT 30 M", "code_information": [{"code": "3101216", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2030.0, "discounted_cash": 1522.5, "setting": "both", "billing_class": "facility"}]}, {"description": "L&D SURG LVL III EA 15M", "code_information": [{"code": "3101219", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 475.0, "discounted_cash": 356.25, "setting": "both", "billing_class": "facility"}]}, {"description": "L&D SURG LVL III INT 30M", "code_information": [{"code": "3101218", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7742.0, "discounted_cash": 5806.5, "setting": "both", "billing_class": "facility"}]}, {"description": "L&D SURG LVL IV EA 15M", "code_information": [{"code": "3101221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 594.0, "discounted_cash": 445.5, "setting": "both", "billing_class": "facility"}]}, {"description": "L&D SURG LVL IV INT 30M", "code_information": [{"code": "3101220", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9677.0, "discounted_cash": 7257.75, "setting": "both", "billing_class": "facility"}]}, {"description": "L/S MYELO W/INJ", "code_information": [{"code": "4902304", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6370.0, "discounted_cash": 4777.5, "setting": "both", "billing_class": "facility"}]}, {"description": "L/S RATIO FETAL LUNG", "code_information": [{"code": "83661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 112.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": 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114.0, "discounted_cash": 85.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LACOSAMIDE", "code_information": [{"code": "80235", "type": "CPT"}, {"code": "7250022", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 27.11, "maximum": 27.11, "gross_charge": 201.0, "discounted_cash": 150.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACOSAMIDE", "code_information": [{"code": "80235", "type": "CPT"}, {"code": "7252554", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 27.11, "maximum": 27.11, "gross_charge": 156.0, "discounted_cash": 117.0, "setting": "both", 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"billing_class": "facility"}]}, {"description": "LACOSAMIDE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327677", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 0.41, "discounted_cash": 0.31, "setting": "both", "billing_class": "facility"}]}, {"description": "LACTATE(LACTIC ACID)", "code_information": [{"code": "83605", "type": "CPT"}, {"code": "4103605", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.46, "gross_charge": 190.0, "discounted_cash": 142.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 54.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER 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"plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACTOFERRIN FECAL QUAL", "code_information": [{"code": "83630", "type": "CPT"}, {"code": "7253630", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 100.08, "gross_charge": 253.0, "discounted_cash": 189.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 100.08, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 103.08, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.24, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.22, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.05, "discounted_cash": 0.04, "setting": "both", "billing_class": "facility"}]}, {"description": "LACTULOSE 10/15 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315451", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 0.05, "discounted_cash": 0.04, "setting": "both", "billing_class": "facility"}]}, {"description": "LACTULOSE 10/15 30ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315459", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LACTULOSE 10/15 30ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": 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CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAM FACETC/FRMT ARTHRD LUM 1", "code_information": [{"code": "63052", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM FACETEC & FORAMOT CRV", "code_information": [{"code": "63045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1204.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1204.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1204.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1204.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1204.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM FACETEC & FORAMOT LUMBAR", "code_information": [{"code": "63047", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "estimated_discounted_cash": 57680.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3399.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3399.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3399.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3399.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3399.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM FACETEC & FORAMOT THRC", "code_information": [{"code": "63046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1151.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1151.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1151.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1151.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1151.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM FACETEC &FORAMOT EA ADDL", "code_information": [{"code": "63048", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "estimated_discounted_cash": 20049.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 208.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 208.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 208.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 208.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 208.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM FACTC/FRMT ARTHRD LUM EA", "code_information": [{"code": "63053", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM W/CORDOTOMY 1STG THRC", "code_information": [{"code": "63197", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1431.91, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1431.91, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1431.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1431.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1431.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMAZE CLASS", "code_information": [{"code": "S9436", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMELLAR BDY FETAL LUNG", "code_information": [{"code": "83664", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 96.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 96.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY ADDL CERVICAL", "code_information": [{"code": "63043", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY ADDL LUMBAR", "code_information": [{"code": "63044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY SINGLE CERVICAL", "code_information": [{"code": "63040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1348.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1348.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1348.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1348.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1348.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY SINGLE LUMBAR", "code_information": [{"code": "63042", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1268.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1268.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1268.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1268.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1268.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMIVUDINE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306345", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LAMIVUDINE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306345", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LAMIVUDINE10M/ML 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315461", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LAMIVUDINE10M/ML 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315461", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LAMOTRIGINE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306347", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LAMOTRIGINE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306347", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LAMOTRIGINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306346", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LAMOTRIGINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306346", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LAMOTRIGINE QUANT", "code_information": [{"code": "80175", "type": "CPT"}, {"code": "7250040", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.67, "gross_charge": 191.0, "discounted_cash": 143.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LANREOTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1930", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.65, "maximum": 34.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 34.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 34.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 34.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LANTHANUM CARB 500MG CTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306361", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 18.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LANTHANUM CARB 500MG CTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306361", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 18.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LAP CLOSE ENTEROSTOMY", "code_information": [{"code": "44227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY PART W/ILEUM", "code_information": [{"code": "44205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1246.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1246.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1246.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1246.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1246.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY W/PROCTECTOMY", "code_information": [{"code": "44211", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.69, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.69, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP COLOSTOMY", "code_information": [{"code": "44188", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1125.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1125.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1125.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1125.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1125.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ENTERECTOMY", "code_information": [{"code": "44202", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1276.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1276.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1276.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1276.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1276.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ENTEROLYSIS", "code_information": [{"code": "44180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 30495.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 851.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 851.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 851.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 851.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 851.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ESOPH LENGTHENING", "code_information": [{"code": "43283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ESOPHAGOMYOTOMY", "code_information": [{"code": "S2079", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP GASTR BYPASS INCL SMLL I", "code_information": [{"code": "43645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1695.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1695.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1695.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP GASTRIC BYPASS/ROUX-EN-Y", "code_information": [{"code": "43644", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1583.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1583.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1583.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1583.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1583.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ILEO/JEJUNO-STOMY", "code_information": [{"code": "44187", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP IMPL ELECTRODE ANTRUM", "code_information": [{"code": "43647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "estimated_discounted_cash": 27463.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ING HERNIA REPAIR INIT", "code_information": [{"code": "49650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 72332.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ING HERNIA REPAIR RECUR", "code_information": [{"code": "49651", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 52734.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP INS DEVICE FOR RT", "code_information": [{"code": "49327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP INSERT TUNNEL IP CATH", "code_information": [{"code": "49324", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 20204.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 364.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 364.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 364.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 364.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 364.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP JEJUNOSTOMY", "code_information": [{"code": "44186", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 605.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 605.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 605.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 605.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 605.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP MOBIL SPLENIC FL ADD-ON", "code_information": [{"code": "44213", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 180.56, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 180.56, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 180.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 180.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 180.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP MYOTOMY HELLER", "code_information": [{"code": "43279", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP PARAESOPH HER RPR W/MESH", "code_information": [{"code": "43282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP PARAESOPHAG HERN REPAIR", "code_information": [{"code": "43281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 79082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NAP", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA SIGNATURE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP PART COLECTOMY W/STOMA", "code_information": [{"code": "44206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1615.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1615.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1615.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1615.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1615.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP PLACE GASTR ADJ DEVICE", "code_information": [{"code": "43770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1023.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1023.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1023.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1023.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1023.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP PROCTOPEXY W/SIG RESECT", "code_information": [{"code": "45402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1416.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1416.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1416.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1416.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1416.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP RADICAL HYST", "code_information": [{"code": "58548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1753.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1753.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1753.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1753.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1753.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP REMOVAL OF RECTUM", "code_information": [{"code": "45395", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1841.46, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1841.46, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1841.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1841.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1841.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP REMOVE RECTUM W/POUCH", "code_information": [{"code": "45397", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1985.63, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1985.63, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1985.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1985.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1985.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP REPLACE GASTR ADJ DEVICE", "code_information": [{"code": "43773", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1165.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1165.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1165.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1165.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1165.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP RESECT S/INTESTINE ADDL", "code_information": [{"code": "44203", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 228.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 228.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 228.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 228.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 228.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP REVISE GASTR ADJ DEVICE", "code_information": [{"code": "43771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1165.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1165.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1165.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1165.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1165.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP REVISE/REMV ELTRD ANTRUM", "code_information": [{"code": "43648", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP REVISION PERM IP CATH", "code_information": [{"code": "49325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 390.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 390.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 390.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 390.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 390.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP RMVL GASTR ADJ ALL PARTS", "code_information": [{"code": "43774", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "estimated_discounted_cash": 44273.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 883.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 883.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 883.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 883.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 883.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP RMVL GASTR ADJ DEVICE", "code_information": [{"code": "43772", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 877.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 877.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 877.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 877.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 877.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP SLEEVE GASTRECTOMY", "code_information": [{"code": "43775", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP W/OMENTOPEXY ADD-ON", "code_information": [{"code": "49326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 175.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 175.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 175.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 175.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 175.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE LIVER CRYOSURG", "code_information": [{"code": "47371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1153.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1153.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1153.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1153.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1153.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE LIVER TUMOR RF", "code_information": [{"code": "47370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1146.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1146.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1146.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1146.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1146.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE RENAL CYST", "code_information": [{"code": "50541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 955.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 955.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 955.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 955.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 955.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE RENAL MASS", "code_information": [{"code": "50542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1209.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1209.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1209.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1209.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1209.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTECTOMY/EXPLR", "code_information": [{"code": "47564", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12537.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13931.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTECTOMY/GRAPH", "code_information": [{"code": "47563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13931.0, "estimated_discounted_cash": 31580.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12537.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13931.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTOENTEROSTOMY", "code_information": [{"code": "47570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 716.26, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 716.26, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 716.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 716.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 716.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO DRAIN LYMPHOCELE", "code_information": [{"code": "49323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 593.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 593.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 593.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 593.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 593.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO LIGATE SPERMATIC VEIN", "code_information": [{"code": "55550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO NEW URETER/BLADDER", "code_information": [{"code": "50947", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO NEW URETER/BLADDER", "code_information": [{"code": "50948", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO PARTIAL COLECTOMY", "code_information": [{"code": "44204", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1424.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1424.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1424.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1424.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1424.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO PARTIAL NEPHRECTOMY", "code_information": [{"code": "50543", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1541.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1541.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1541.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1541.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1541.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO RADICAL NEPHRECTOMY", "code_information": [{"code": "50545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1393.56, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1393.56, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1393.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1393.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1393.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVAL DONOR KIDNEY", "code_information": [{"code": "50547", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1521.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1521.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1521.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1521.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1521.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVE W/URETER", "code_information": [{"code": "50548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1404.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1404.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1404.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1404.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1404.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO SLING OPERATION", "code_information": [{"code": "51992", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO TOTAL PROCTOCOLECTOMY", "code_information": [{"code": "44210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1653.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1653.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1653.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1653.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1653.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO TOTAL PROCTOCOLECTOMY", "code_information": [{"code": "44212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1902.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1902.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1902.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1902.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1902.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO URETHRAL SUSPENSION", "code_information": [{"code": "51990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 772.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 772.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 772.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 772.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 772.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-ASST VAG HYSTERECTOMY", "code_information": [{"code": "58550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-MYOMECTOMY COMPLEX", "code_information": [{"code": "58546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST COMPLEX", "code_information": [{"code": "58553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1118.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1118.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1118.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1118.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1118.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST INCL T/O", "code_information": [{"code": "58552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 16241.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST W/T/O COMPL", "code_information": [{"code": "58554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1281.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1281.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1281.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1281.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1281.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPE PROC RECTUM", "code_information": [{"code": "45499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY", "code_information": [{"code": "47562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13931.0, "estimated_discounted_cash": 34485.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12537.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13931.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC", "code_information": [{"code": "418", "type": "MS-DRG"}], "standard_charges": [{"minimum": 56164.5, "maximum": 70774.85, "estimated_discounted_cash": 130993.4, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 56164.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 70774.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "417", "type": "MS-DRG"}], "standard_charges": [{"minimum": 79233.25, "maximum": 99844.59, "estimated_discounted_cash": 114068.25, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 79233.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 99844.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "419", "type": "MS-DRG"}], "standard_charges": [{"minimum": 45347.29, "maximum": 57143.71, "estimated_discounted_cash": 110508.65, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 45347.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 57143.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC MYOMECTOMY", "code_information": [{"code": "58545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC NEPHRECTOMY", "code_information": [{"code": "50546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1240.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1240.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1240.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1240.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1240.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC PROC", "code_information": [{"code": "45400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1063.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1063.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1063.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1063.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1063.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ADRENALECTOMY", "code_information": [{"code": "60650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1143.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1143.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1143.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1143.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1143.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY APPENDECTOMY", "code_information": [{"code": "44970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 21860.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 543.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 543.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 543.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 543.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 543.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ASPIRATION", "code_information": [{"code": "49322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY BIOPSY", "code_information": [{"code": "49321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1537.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY EXCISE LESIONS", "code_information": [{"code": "58662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 55262.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY FIMBRIOPLASTY", "code_information": [{"code": "58672", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY FUNDOPLASTY", "code_information": [{"code": "43280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NAP", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA SIGNATURE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1003.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1003.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1003.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1003.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1003.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY GASTROSTOMY", "code_information": [{"code": "43653", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ISLET CELL TRANS", "code_information": [{"code": "G0342", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPH NODE BIOP", "code_information": [{"code": "38570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPHADENECTOMY", "code_information": [{"code": "38571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "estimated_discounted_cash": 55306.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPHADENECTOMY", "code_information": [{"code": "38572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYSIS", "code_information": [{"code": "58660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ORCHIECTOMY", "code_information": [{"code": "54690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ORCHIOPEXY", "code_information": [{"code": "54692", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3113.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY PYELOPLASTY", "code_information": [{"code": "50544", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1301.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1301.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1301.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1301.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1301.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY REMOVE ADNEXA", "code_information": [{"code": "58661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 17038.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SALPINGOSTOMY", "code_information": [{"code": "58673", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SPLENECTOMY", "code_information": [{"code": "38120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 976.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 976.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 976.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 976.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 976.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SURG COLPOPEXY", "code_information": [{"code": "57425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 19654.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 942.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 942.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 942.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 942.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 942.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY TUBAL BLOCK", "code_information": [{"code": "58671", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY TUBAL CAUTERY", "code_information": [{"code": "58670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY URETEROLITHOTOMY", "code_information": [{"code": "50945", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1026.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1026.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1026.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1026.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1026.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VAGUS NERVE", "code_information": [{"code": "43651", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 601.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 601.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 601.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 601.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 601.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VAGUS NERVE", "code_information": [{"code": "43652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 713.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 713.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 713.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 713.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 713.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROTOMY ISLET CELL TRANSP", "code_information": [{"code": "G0343", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS ABLTJ UTERINE FIBROIDS", "code_information": [{"code": "58674", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS ESOPHGL SPHNCTR AGMNTJ", "code_information": [{"code": "43284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS 1LD", "code_information": [{"code": "675T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS EA", "code_information": [{"code": "676T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT PRM ISDSS", "code_information": [{"code": "674T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS ISLET CELL TRANSPLANT", "code_information": [{"code": "585T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS PELVIC LYMPHADEC", "code_information": [{"code": "38573", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS 1ST LD", "code_information": [{"code": "677T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS EA ADD", "code_information": [{"code": "678T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS RMVL LEAD ISDSS", "code_information": [{"code": "679T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS SURG PRST8ECT RPBIC RAD", "code_information": [{"code": "55866", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 97202.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1802.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1802.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1802.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1802.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1802.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS SURG PRST8ECT SMPL STOT", "code_information": [{"code": "55867", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS TOT HYST RESJ MAL", "code_information": [{"code": "58575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGE DISPOSABLE UNDERPAD", "code_information": [{"code": "T4541", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARGSC W/LASER DSTRJ LES", "code_information": [{"code": "31572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/NJX AUGMENTATION", "code_information": [{"code": "31574", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/REMOVAL LESION", "code_information": [{"code": "31578", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/RMVL FOREIGN BDY(S)", "code_information": [{"code": "31577", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 178.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/THER INJECTION", "code_information": [{"code": "31573", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARONIDASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1931", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.88, "maximum": 39.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 35.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 39.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGEAL FUNCTION STUDIES", "code_information": [{"code": "92520", "type": "CPT"}], "standard_charges": [{"minimum": 47.02, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 47.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 47.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 47.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 47.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 47.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY CRICOID SPLIT", "code_information": [{"code": "31587", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 957.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 957.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 957.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 957.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 957.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY FX RDCTJ FIXJ", "code_information": [{"code": "31584", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1515.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1515.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1515.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1515.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1515.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL WEB", "code_information": [{"code": "31580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY MEDIALIZATION", "code_information": [{"code": "31591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOP W/ARYTENOIDECTOM", "code_information": [{"code": "31560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOP W/VC INJ + SCOPE", "code_information": [{"code": "31571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE W/VC INJ", "code_information": [{"code": "31570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY I&R", "code_information": [{"code": "92615", "type": "CPT"}], "standard_charges": [{"minimum": 35.9, "maximum": 35.9, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.9, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY VID", "code_information": [{"code": "92614", "type": "CPT"}], "standard_charges": [{"minimum": 123.35, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 157.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 126.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 123.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 141.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 141.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 141.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 157.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 157.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 157.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 157.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31528", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31529", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR ASPIRATION", "code_information": [{"code": "31515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR TREATMENT", "code_information": [{"code": "31527", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY TELESCOPIC", "code_information": [{"code": "31579", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/BIOPSY", "code_information": [{"code": "31535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 19505.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/BX & OP SCOPE", "code_information": [{"code": "31536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/EXC OF TUMOR", "code_information": [{"code": "31540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15890.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB & OP SCOPE", "code_information": [{"code": "31531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB REMOVAL", "code_information": [{"code": "31530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY WITH BIOPSY", "code_information": [{"code": "31510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY WITH BIOPSY", "code_information": [{"code": "31576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNSCOP REMVE CART + SCOP", "code_information": [{"code": "31561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNSCOP W/TUMR EXC + SCOPE", "code_information": [{"code": "31541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14716.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER IN SITU KERATOMILEUSIS", "code_information": [{"code": "S0800", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER SURG PENIS LESION(S)", "code_information": [{"code": "54057", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY ANAL LESIONS", "code_information": [{"code": "46917", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 889.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY EYE STRANDS", "code_information": [{"code": "67031", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF CERVIX", "code_information": [{"code": "57513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17311.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52648", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 19102.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER TREATMENT OF RETINA", "code_information": [{"code": "67039", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER TREATMENT OF RETINA", "code_information": [{"code": "67040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAT RETINACULAR RELEASE OPEN", "code_information": [{"code": "27425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAUNDRY SERV,EXT,PROF,/ORDER", "code_information": [{"code": "S5175", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAUP", "code_information": [{"code": "S2080", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LD ACUITY X4 SPRL L 4677", "code_information": [{"code": "C1900", "type": "HCPCS"}, {"code": "4008569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2682.75, "maximum": 2682.75, "gross_charge": 12775.0, "discounted_cash": 9581.25, 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"standard_charge_dollar": 372.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 323.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 314.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 372.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 372.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 372.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 372.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LE ART IMAGING UNI/LTD", "code_information": [{"code": "93926", "type": "CPT"}, {"code": "4636046", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 153.23, "maximum": 233.14, "gross_charge": 2320.0, "discounted_cash": 1740.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 233.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 157.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 153.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 233.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 233.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 233.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 233.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD QUANTITATIVE", "code_information": [{"code": "83655", "type": "CPT"}, {"code": "7253655", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.72, "gross_charge": 275.0, "discounted_cash": 206.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD QUANTITATIVE/2", "code_information": [{"code": "83655", "type": "CPT"}, {"code": "7253656", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.72, "gross_charge": 154.0, "discounted_cash": 115.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD QUANTITATIVE/4", "code_information": [{"code": "83655", "type": "CPT"}, {"code": "7253658", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.72, "gross_charge": 154.0, "discounted_cash": 115.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD QUANTITATIVE/5", "code_information": [{"code": "83655", "type": "CPT"}, {"code": "7253666", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.72, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD, NEUROSTIM TEST KIT", "code_information": [{"code": "C1897", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEAD, PMKR, TRANSVENOUS VDD", "code_information": [{"code": "C1779", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEAD, PMKR/AICD COMBINATION", "code_information": [{"code": "C1899", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT I-1 PIECE W/ GRAFT", "code_information": [{"code": "21145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1511.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1511.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1511.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1511.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1511.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT I-1 PIECE W/O GRAFT", "code_information": [{"code": "21141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1316.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1316.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1316.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1316.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1316.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT I-2 PIECE W/ GRAFT", "code_information": [{"code": "21146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1495.1, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1495.1, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1495.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1495.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1495.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT I-2 PIECE W/O GRAFT", "code_information": [{"code": "21142", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1281.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1281.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1281.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1281.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1281.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT I-3/> PIECE W/ GRAFT", "code_information": [{"code": "21147", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1623.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1623.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1623.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1623.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1623.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT I-3/> PIECE W/O GRAFT", "code_information": [{"code": "21143", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1359.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1359.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1359.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1359.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1359.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT II ANTERIOR INTRUSION", "code_information": [{"code": "21150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT II W/BONE GRAFTS", "code_information": [{"code": "21151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1849.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1849.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1849.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1849.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1849.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/ LEFORT I", "code_information": [{"code": "21155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2362.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2362.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2362.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2362.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2362.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/FHD W/ LEFORT I", "code_information": [{"code": "21160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2894.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2894.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2894.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2894.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2894.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/FHDW/O LEFORT I", "code_information": [{"code": "21159", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2728.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2728.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2728.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2728.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2728.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/O LEFORT I", "code_information": [{"code": "21154", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2079.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2079.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2079.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2079.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2079.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEG VEIN FUSION", "code_information": [{"code": "34530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1012.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1012.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1012.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1012.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1012.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA DIR PROB", "code_information": [{"code": "87540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 102.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 102.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA QUANT", "code_information": [{"code": "87542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 212.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 212.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGIONELLA AMP PROBE", "code_information": [{"code": "87541", "type": "CPT"}, {"code": "7007541", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "gross_charge": 646.0, "discounted_cash": 484.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGIONELLA ANTIBODY", "code_information": [{"code": "86713", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 78.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 78.07, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGIONELLA PNEUMOPHILA", "code_information": [{"code": "87278", "type": "CPT"}, {"code": "7257279", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 255.0, "discounted_cash": 191.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEISHMANIA ANTIBODY", "code_information": [{"code": "86717", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 62.49, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHEN METACARPAL/FINGER", "code_information": [{"code": "26568", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHEN RADIUS & ULNA", "code_information": [{"code": "25393", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHEN RADIUS OR ULNA", "code_information": [{"code": "25391", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF HAND TENDON", "code_information": [{"code": "26478", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF PALATE", "code_information": [{"code": "42226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF PALATE", "code_information": [{"code": "42227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 980.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 980.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 980.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 980.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 980.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH BONE", "code_information": [{"code": "27466", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1172.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1172.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1172.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1172.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1172.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDON", "code_information": [{"code": "27393", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDONS", "code_information": [{"code": "27394", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDONS", "code_information": [{"code": "27395", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEPIRUDIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1945", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.49, "maximum": 570.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 513.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 570.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 570.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 570.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 570.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEPTIN", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "7258320", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.03, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEPTOSPIRA AB", "code_information": [{"code": "86720", "type": "CPT"}, {"code": "7256178", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "gross_charge": 190.0, "discounted_cash": 142.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LESION DESTRUCTION", "code_information": [{"code": "D7465", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LETROZOLE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306368", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LETROZOLE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306368", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEUCOVORIN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5306393", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEUCOVORIN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5306393", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEUCOVORIN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5306389", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEUCOVORIN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5306389", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEUKACYTE TRANSFUSION", "code_information": [{"code": "86950", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKO ASSMT FECAL QL/SQN", "code_information": [{"code": "89055", "type": "CPT"}, {"code": "4107203", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.75, "gross_charge": 97.0, "discounted_cash": 72.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE ALKA-PHSPHTASE", "code_information": [{"code": "85540", "type": "CPT"}, {"code": "7255540", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.87, "gross_charge": 320.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 43.87, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE HISTAMINE RELEASE", "code_information": [{"code": "86343", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.41, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE PHAGOCYTOSIS", "code_information": [{"code": "86344", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 40.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 40.73, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUPROLID DEP 3.75MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1950", "type": "HCPCS"}, {"code": "5321668", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1557.29, "maximum": 1730.32, "gross_charge": 9710.0, "discounted_cash": 7282.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1557.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1730.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1730.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1730.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1730.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUPROLID DEP 3.75MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1950", "type": "HCPCS"}, {"code": "5321668", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1557.29, "maximum": 1730.32, "gross_charge": 9710.0, "discounted_cash": 7282.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1557.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1730.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1730.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1730.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1730.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUPROLID DEP PER7.5MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9217", "type": "HCPCS"}, {"code": "5321676", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 158.81, "maximum": 176.45, "gross_charge": 904.0, "discounted_cash": 678.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 158.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 176.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 176.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 176.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 176.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUPROLID DEP PER7.5MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9217", "type": "HCPCS"}, {"code": "5321676", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 158.81, "maximum": 176.45, "gross_charge": 904.0, "discounted_cash": 678.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 158.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 176.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 176.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 176.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 176.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE ACETATE IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9219", "type": "HCPCS"}], "standard_charges": [{"minimum": 4337.84, "maximum": 4819.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4337.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4819.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4819.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4819.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4819.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE DEPOT CIPLA 7.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1954", "type": "HCPCS"}], "standard_charges": [{"minimum": 636.0, "maximum": 706.67, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 636.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 706.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 706.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 706.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 706.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE INJ, CAMCEVI, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1952", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.03, "maximum": 78.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 78.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 78.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 78.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 78.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEV 1 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0380", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 1863.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1162.0, "methodology": "case rate"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 450.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1478.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1863.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEV 2 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0381", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 1863.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1162.0, "methodology": "case rate"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 450.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1478.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1863.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEV 3 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0382", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 3593.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3106.0, "methodology": "case rate"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 450.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2850.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3593.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEV 4 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0383", "type": "HCPCS"}], "standard_charges": [{"minimum": 7545.0, "maximum": 9506.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7545.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9506.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEV 5 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0384", "type": "HCPCS"}], "standard_charges": [{"minimum": 7545.0, "maximum": 9506.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7545.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9506.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7615", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.82, "maximum": 3.13, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7612", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.24, "maximum": 0.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7614", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.08, "maximum": 0.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVAMISOLE 50 MG", "code_information": [{"code": "S0177", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.17, "maximum": 5.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5.74, "methodology": "fee 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306405", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVETIRACETAM 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306405", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVETIRACETAM 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306406", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVETIRACETAM 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306406", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVETIRACETAM500MG/5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315478", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVETIRACETAM500MG/5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315478", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOCARNITINE 330MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302070", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOCARNITINE 330MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302070", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306430", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306430", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306431", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306431", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN 750MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306428", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN 750MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306428", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVONORG(MIRENA)52MG IUD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7298", "type": "HCPCS"}, {"code": "5336185", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1246.21, "maximum": 1384.68, "gross_charge": 4618.0, "discounted_cash": 3463.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1246.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1384.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1384.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1384.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1384.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVONORG(MIRENA)52MG IUD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7298", "type": "HCPCS"}, {"code": "5336185", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1246.21, "maximum": 1384.68, "gross_charge": 4618.0, "discounted_cash": 3463.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1246.21, "methodology": "fee 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{"description": "LEVONORGESTREL 1.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306433", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 108.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVONORGESTREL IMPLANT SYS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7306", "type": "HCPCS"}], "standard_charges": [{"minimum": 545.91, "maximum": 606.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 545.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 606.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 606.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 606.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 606.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVORPHANOL TARTRATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1960", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.85, "maximum": 3.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .025MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306447", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .025MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306447", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .05MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306451", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .05MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306451", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .075MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306454", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .075MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306454", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .088MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306435", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .088MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306435", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .112MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306456", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .112MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306456", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .125MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306458", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .125MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306458", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .137MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306457", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .137MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306457", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306455", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306455", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306459", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306459", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE", "code_information": [{"code": "80176", "type": "CPT"}, {"code": "7253610", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.9, "gross_charge": 254.0, "discounted_cash": 190.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE D5W PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2002", "type": "HCPCS"}, {"code": "5321753", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE D5W PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2002", "type": "HCPCS"}, {"code": "5321753", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE VISC 2% 100 LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315505", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE VISC 2% 100 LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315505", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE VISC 2% 15MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315506", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE VISC 2% 15MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315506", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE VISC 2% 20 LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315503", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE VISC 2% 20 LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315503", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LIFESTYLE MOD 1ST STAGE", "code_information": [{"code": "S0340", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIFESTYLE MOD 2 OR 3 STAGE", "code_information": [{"code": "S0341", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIFESTYLE MOD 4TH STAGE", "code_information": [{"code": "S0342", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATE AV FISTULA", "code_information": [{"code": "4917607", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 18530.0, "discounted_cash": 13897.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGATE ESOPHAGUS VEINS", "code_information": [{"code": "43400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1458.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1458.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1458.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1458.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1458.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS OPEN", "code_information": [{"code": "37761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS RADICAL", "code_information": [{"code": "37760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE OVIDUCT(S) ADD-ON", "code_information": [{"code": "58611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE/DIVIDE/EXCISE VEIN", "code_information": [{"code": "37785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE/STAPLE ESOPHAGUS", "code_information": [{"code": "43405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1389.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1389.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1389.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1389.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1389.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP LONG LEG VEIN", "code_information": [{"code": "37722", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP SHORT LEG VEIN", "code_information": [{"code": "37718", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION NASAL SINUS ARTERY", "code_information": [{"code": "30915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF A-V FISTULA", "code_information": [{"code": "37607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF ABDOMEN ARTERY", "code_information": [{"code": "37617", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1291.48, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1291.48, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1291.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1291.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1291.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF CHEST ARTERY", "code_information": [{"code": "37616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1083.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1083.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1083.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1083.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1083.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF EXTREMITY ARTERY", "code_information": [{"code": "37618", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 383.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 383.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 383.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 383.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 383.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF HEMORRHOID(S)", "code_information": [{"code": "46221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 11209.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 117.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 117.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 117.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 117.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 117.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF INF VENA CAVA", "code_information": [{"code": "37619", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 828.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 828.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 828.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 828.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 828.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 551.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 551.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 551.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 551.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 551.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 472.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 472.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 472.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 472.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 472.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK VEIN", "code_information": [{"code": "37565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 696.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 696.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 696.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 696.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 696.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SALIVARY DUCT", "code_information": [{"code": "42665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SHUNT", "code_information": [{"code": "49428", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 415.07, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 415.07, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 415.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 415.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 415.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION UPPER JAW ARTERY", "code_information": [{"code": "30920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LILETTA, 52 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7297", "type": "HCPCS"}], "standard_charges": [{"minimum": 955.96, "maximum": 1062.18, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 955.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1062.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1062.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1062.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1062.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMB EXERCISE TEST", "code_information": [{"code": "95875", "type": "CPT"}], "standard_charges": [{"minimum": 108.06, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 108.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 108.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 108.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 108.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 108.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMB NERVE SURGERY ADD-ON", "code_information": [{"code": "64783", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIMB REATTACHMENT, HIP AND FEMUR 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 56.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 56.62, "methodology": "fee 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"LINGUAL FRENECTOMY", "code_information": [{"code": "D7962", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIOTHYRONINE 50MCG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306519", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LIOTHYRONINE 50MCG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306519", 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"standard_charge_dollar": 18.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPID PANEL/2", "code_information": [{"code": "80061", "type": "CPT"}, {"code": "7250160", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.96, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US 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"plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIPOPROTEIN BY NMR", "code_information": [{"code": "83704", "type": "CPT"}, {"code": "7253704", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 160.89, "gross_charge": 611.0, "discounted_cash": 458.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 160.89, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.08, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 44.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": 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"drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327608", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 64.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LISDEXAMFETAMINE 20MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327608", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 64.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LISDEXAMFETAMINE 30MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327611", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 64.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LISDEXAMFETAMINE 30MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327611", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 64.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LISINOPRIL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306636", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LISINOPRIL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306636", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LISINOPRIL 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306634", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LISINOPRIL 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306634", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LISINOPRIL 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306637", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LISINOPRIL 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306637", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LISINOPRIL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306635", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LISINOPRIL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306635", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LISTERIA MONOCYTOGENES AB", "code_information": [{"code": "86723", "type": "CPT"}, {"code": "7256723", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "gross_charge": 630.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM", "code_information": [{"code": "80178", "type": "CPT"}, {"code": "4103725", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.73, "gross_charge": 320.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.73, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM 150MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306674", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LITHIUM 150MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306674", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LITHIUM 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306652", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LITHIUM 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306652", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LITHIUM 450MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306676", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LITHIUM 450MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306676", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LITHIUM CARB 300MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306678", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LITHIUM CARB 300MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306678", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LITHIUM300MG/5ML 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315485", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LITHIUM300MG/5ML 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315485", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LITHOTRIPSY", "code_information": [{"code": "3080590", "type": "CDM"}, {"code": "790", "type": "RC"}], "standard_charges": [{"gross_charge": 62348.0, "discounted_cash": 46761.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LITHOTRIPSY OTHER", "code_information": [{"code": "3080015", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 58858.0, "discounted_cash": 44143.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LITT ICR 1 TRAJ 1 SMPL LES", "code_information": [{"code": "61736", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LITT ICR MLT TRJ MLT/CPLX LS", "code_information": [{"code": "61737", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER & SPLEEN IMAGE/FLOW", "code_information": [{"code": "78216", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 427.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 427.75, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 175.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 175.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 175.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 175.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 175.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER BX W/OTHER PROC", "code_information": [{"code": "4918220", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2855.0, "discounted_cash": 2141.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LIVER DS 10 BIOCHEM ASY SRM", "code_information": [{"code": "166U", "type": "CPT"}], "standard_charges": [{"minimum": 503.4, "maximum": 503.4, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 503.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 503.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER DS ALYS 3 BMRK SRM ALG", "code_information": [{"code": "81517", "type": "CPT"}, {"code": "7250255", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 176.19, "maximum": 176.19, "gross_charge": 929.0, "discounted_cash": 696.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 176.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 176.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER ELASTOGRAPHY", "code_information": [{"code": "91200", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING STATIC", "code_information": [{"code": "78201", "type": "CPT"}, {"code": "5208201", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1221.78, "gross_charge": 5818.0, "discounted_cash": 4363.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1221.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 375.06, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING WITH FLOW", "code_information": [{"code": "78202", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 489.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 442.81, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 215.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 215.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 215.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 215.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 215.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT", "code_information": 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"standard_charge_dollar": 86994.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 143119.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 194353.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 110623.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 91862.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 205231.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 151129.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 151129.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 91862.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 110623.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 205231.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 91862.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 151129.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 110623.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 205231.16, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 87362.37, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 78532.99, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 155972.74, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 106316.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 342329.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 431381.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [{"code": "6", "type": "MS-DRG"}], "standard_charges": [{"minimum": 103715.26, "maximum": 270742.55, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 116912.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 243665.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 171333.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 148734.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 256392.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 180282.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 156502.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 123018.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 270742.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 129903.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165261.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 190372.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 190372.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 129903.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165261.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 270742.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 190372.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 129903.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165261.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 270742.55, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 150736.16, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 226605.2, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 129621.57, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 103715.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 153957.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 194007.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER/SPLEEN IMAG STATIC", "code_information": [{"code": "78215", "type": "CPT"}, {"code": "5208215", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 658.14, "gross_charge": 3134.0, "discounted_cash": 2350.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 658.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 431.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 204.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE 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"standard_charge_dollar": 204.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 204.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LNGVTY&MRTLTY RSK MRNA 18GEN", "code_information": [{"code": "294U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, 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[{"minimum": 124.65, "maximum": 138.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 124.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 138.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 138.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 138.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS 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{"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LOPERAMIDE 2MG/15ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315508", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LOPINAV/RITONA 200/50 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306731", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LOPINAV/RITONA 200/50 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306731", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LORATADINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306740", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LORATADINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306740", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LORATADINE 5MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315544", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.85, "discounted_cash": 0.64, "setting": "both", "billing_class": "facility"}]}, {"description": "LORATADINE 5MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315544", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 0.85, "discounted_cash": 0.64, "setting": "both", "billing_class": "facility"}]}, {"description": "LORAZEPAM .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306749", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LORAZEPAM .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306749", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LORAZEPAM 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306752", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LORAZEPAM 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306752", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LORAZEPAM 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306756", "type": 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{"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LOSARTAN 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306757", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LOSARTAN 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306757", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LOUDNESS BALANCE TEST", "code_information": [{"code": "92562", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW BACK DISK SURGERY", "code_information": [{"code": "63030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "estimated_discounted_cash": 31692.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2974.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2974.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2974.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2974.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2974.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5271", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5272", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5273", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4898.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5274", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5275", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4898.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5276", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5277", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4898.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5278", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW DENSITY LIPOPROTEIN(LDL)", "code_information": [{"code": "S2120", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW EXTEMITY NEUR EXAM DOCUM", "code_information": [{"code": "G8404", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW EXTEMITY NEUR NOT PERFOR", "code_information": [{"code": "G8405", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW NTSTY ESWT CORPUS CVRNSM", "code_information": [{"code": "864T", "type": "CPT"}], "standard_charges": [{"minimum": 557.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW-LEVEL LASER THERAPY", "code_information": [{"code": "552T", "type": "CPT"}], "standard_charges": [{"minimum": 3243.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW-LEVEL LASER TRMT 15 MIN", "code_information": [{"code": "S8948", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOWER EXT INFANT AP&LAT", "code_information": [{"code": "73592", "type": "CPT"}, {"code": "4903591", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 182.07, "gross_charge": 867.0, "discounted_cash": 650.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 182.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOWER EXT INFANT AP&LAT", "code_information": [{"code": "73592", "type": "CPT"}, {"code": "5013591", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 182.07, "gross_charge": 867.0, "discounted_cash": 650.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 182.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC", "code_information": [{"code": "493", "type": "MS-DRG"}], "standard_charges": [{"minimum": 84203.59, "maximum": 106107.89, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 84203.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 106107.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC", "code_information": [{"code": "492", "type": "MS-DRG"}], "standard_charges": [{"minimum": 121904.46, "maximum": 153616.07, "estimated_discounted_cash": 41681.85, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 121904.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 153616.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC", "code_information": [{"code": "494", "type": "MS-DRG"}], "standard_charges": [{"minimum": 66619.81, "maximum": 83949.95, "estimated_discounted_cash": 92182.64, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 66619.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 83949.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOWER JAW BONE GRAFT", "code_information": [{"code": "21215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOXAPINE 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306783", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LOXAPINE 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306783", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LOXAPINE 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306774", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LOXAPINE 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306774", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LOXAPINE FOR INHALATION 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2062", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.39, "maximum": 17.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LP-PLA2 (PLAC)", "code_information": [{"code": "83698", "type": "CPT"}, {"code": "7253643", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 173.12, "gross_charge": 518.0, "discounted_cash": 388.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 173.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 47.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 47.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 47.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 47.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 47.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LPOPRTN BLD W/5 MAJ CLASSES", "code_information": [{"code": "52U", "type": "CPT"}], "standard_charges": [{"minimum": 33.86, "maximum": 33.86, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LSH UTERUS 250 G OR LESS", "code_information": [{"code": "58541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 829.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 829.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 829.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 829.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 829.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LSH UTERUS ABOVE 250 G", "code_information": [{"code": "58543", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 20221.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 932.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 932.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 932.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 932.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 932.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LSH W/T/O UT 250 G OR LESS", "code_information": [{"code": "58542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 22211.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 917.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 917.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 917.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 917.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 917.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LSH W/T/O UTERUS ABOVE 250 G", "code_information": [{"code": "58544", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1006.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1006.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1006.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1006.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1006.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LU GNOTYP BCAM EXON 3", "code_information": [{"code": "196U", "type": "CPT"}], "standard_charges": [{"minimum": 185.2, "maximum": 185.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUMB BENDNG 2 OR 3 VWS", "code_information": [{"code": "72120", "type": "CPT"}, {"code": "4902121", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 121.68, "gross_charge": 467.0, "discounted_cash": 350.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 98.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 121.68, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUMB BENDNG 2 OR 3 VWS", "code_information": [{"code": "72120", "type": "CPT"}, {"code": "5012121", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 121.68, "gross_charge": 467.0, "discounted_cash": 350.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 98.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 121.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUMIZYME INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0221", "type": "HCPCS"}], "standard_charges": [{"minimum": 185.93, "maximum": 206.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 185.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 206.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 206.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 206.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 206.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG BX PLUG W/DEL SYS", "code_information": [{"code": "C2613", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERF PARTICULATE", "code_information": [{"code": "78580", "type": "CPT"}, {"code": "5208580", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 495.18, "gross_charge": 2358.0, "discounted_cash": 1768.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 495.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 490.48, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 234.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 234.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 234.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 234.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 234.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERF&VENTILAT DIFF", "code_information": [{"code": "78598", "type": "CPT"}, {"code": "5208589", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1129.37, "gross_charge": 2846.0, "discounted_cash": 2134.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 597.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1129.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION DIFFER", "code_information": [{"code": "78597", "type": "CPT"}, {"code": "5208598", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 537.41, "gross_charge": 2396.0, "discounted_cash": 1797.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 503.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 537.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT", "code_information": [{"code": "7", "type": "MS-DRG"}], "standard_charges": [{"minimum": 116145.09, "maximum": 541823.42, "estimated_discounted_cash": 49431.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 282961.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 130438.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 166756.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 116145.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 297740.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 137251.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 175466.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 122211.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 129051.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 185287.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 314404.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 144933.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 129051.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 185287.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 144933.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 314404.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 144933.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 129051.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 185287.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 314404.71, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 284332.78, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 118779.22, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 129919.01, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 143542.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 429972.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 541823.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT DOUBLE", "code_information": [{"code": "32853", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3178.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3178.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3178.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3178.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3178.94, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT SINGLE", "code_information": [{"code": "32851", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2666.99, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2666.99, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2666.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2666.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2666.99, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2988.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2988.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2988.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2988.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2988.2, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32854", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3449.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3449.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3449.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3449.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3449.32, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG VENT&PERF IMAGING", "code_information": [{"code": "78582", "type": "CPT"}, {"code": "5208583", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1237.11, "gross_charge": 4104.0, "discounted_cash": 3078.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 861.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1237.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILATION IMAGING", "code_information": [{"code": "78579", "type": "CPT"}, {"code": "5208579", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 574.77, "gross_charge": 2737.0, "discounted_cash": 2052.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 574.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 501.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VOL GAS DIL/WASHOUT", "code_information": [{"code": "94727", "type": "CPT"}, {"code": "5504727", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "gross_charge": 675.0, "discounted_cash": 506.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VOLUME REDUCTION", "code_information": [{"code": "32491", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1476.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1476.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1476.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1476.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1476.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LURASIDONE 120MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306801", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LURASIDONE 120MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306801", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LURASIDONE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306797", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 255.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LURASIDONE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306797", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 255.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LURASIDONE 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306798", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 253.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LURASIDONE 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306798", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 253.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LURASIDONE 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306796", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 246.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LURASIDONE 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306796", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 246.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LURASIDONE 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306799", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 249.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LURASIDONE 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306799", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 249.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LUSPATERCEPT-AAMT PER 0.25MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0896", "type": "HCPCS"}, {"code": "5321915", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 37.78, "maximum": 41.98, "gross_charge": 190.0, "discounted_cash": 142.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 41.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 41.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 41.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 41.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUSPATERCEPT-AAMT PER 0.25MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0896", "type": "HCPCS"}, {"code": "5321915", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 37.78, "maximum": 41.98, "gross_charge": 190.0, "discounted_cash": 142.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 41.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 41.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 41.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 41.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUTEINING HORMONE", "code_information": [{"code": "83002", "type": "CPT"}, {"code": "4103002", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.46, "gross_charge": 541.0, "discounted_cash": 405.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 94.46, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUTEINING HORMONE", "code_information": [{"code": "83002", "type": "CPT"}, {"code": "7253002", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.46, "gross_charge": 116.0, "discounted_cash": 87.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 94.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUTENIZING RELEASE FACTR", "code_information": [{"code": "83727", "type": "CPT"}, {"code": "7253727", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 87.67, "gross_charge": 166.0, "discounted_cash": 124.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 87.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 128613.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33077.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 350457.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 37652.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 128613.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33077.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 350457.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 37652.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 350457.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33077.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 128613.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 37652.02, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 115164.23, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 28278.03, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 237700.63, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 32187.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 54165.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 68256.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "840", "type": "MS-DRG"}], "standard_charges": [{"minimum": 107405.15, "maximum": 135344.98, "estimated_discounted_cash": 91274.49, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 107405.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 135344.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC", "code_information": [{"code": "824", "type": "MS-DRG"}], "standard_charges": [{"minimum": 75222.45, "maximum": 94790.44, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 75222.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 94790.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [{"code": "823", "type": "MS-DRG"}], "standard_charges": [{"minimum": 152224.53, "maximum": 191823.45, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 152224.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 191823.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "825", "type": "MS-DRG"}], "standard_charges": [{"minimum": 44802.78, "maximum": 56457.55, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44802.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 56457.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [{"code": "842", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20125.72, "maximum": 177111.21, "estimated_discounted_cash": 95505.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 65735.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 159398.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 22466.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34847.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 69168.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23640.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36667.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 167724.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38719.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24963.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 73040.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 177111.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 73040.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 177111.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24963.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38719.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 177111.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 73040.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24963.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38719.92, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 26065.47, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 129967.28, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 20125.72, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 44992.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33547.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42274.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN INIT DAY", "code_information": [{"code": "32561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN SUBQ DAY", "code_information": [{"code": "32562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSIS + LAVAGE W CATHETERS", "code_information": [{"code": "D7871", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS INTRANASAL SYNECHIA", "code_information": [{"code": "30560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSIS OF LABIAL LESION(S)", "code_information": [{"code": "56441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSIS PENIL CIRCUMIC LESION", "code_information": [{"code": "54162", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lang comp current status", "code_information": [{"code": "G9159", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lang comp d/c status", "code_information": [{"code": "G9161", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lang comp goal status", "code_information": [{"code": "G9160", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lang express current status", "code_information": [{"code": "G9162", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lang express d/c status", "code_information": [{"code": "G9164", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lang express goal status", "code_information": [{"code": "G9163", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lanthanum carbonate, oral, 5 mg (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0607", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Lanthanum carbonate, oral, powder, 5 mg, not therapeutically equivalent to J0607 (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0608", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.06, "maximum": 0.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Lap esoph augmentation", "code_information": [{"code": "C9737", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Laser Treatment Of Open Wound, First 20 Sq Cm Or Less", "code_information": [{"code": "491T", "type": "CPT"}], "standard_charges": [{"minimum": 12252.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ldct for lung ca screen", "code_information": [{"code": "G0297", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ldl 100 and over", "code_information": [{"code": "G9272", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ldl < 100", "code_information": [{"code": "G8595", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ldl >= 100", "code_information": [{"code": "G8597", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ldl under 100", "code_information": [{"code": "G9271", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ldl-c <100mg/dl", "code_information": [{"code": "G8736", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ldl-c >=100mg/dl", "code_information": [{"code": "G8737", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ldl-c not performed", "code_information": [{"code": "G8894", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ldl-c not under control", "code_information": [{"code": "G8893", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ldl-c under control", "code_information": [{"code": "G8890", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ldlc not pres w/i 12 mo prir", "code_information": [{"code": "G8943", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Leave Of Absence General", "code_information": [{"code": "180", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Leave Of Absence Nursing Home (For Hospitalization)", "code_information": [{"code": "185", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Leave Of Absence Other", "code_information": [{"code": "189", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Leave Of Absence Patience Convenience - Charges Billable", "code_information": [{"code": "182", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Leave Of Absence Therapeutic Leave", "code_information": [{"code": "183", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Less 1.2 kt/v", "code_information": [{"code": "G8717", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Less 1.7 kt/v per week", "code_information": [{"code": "G8720", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Linear acc based stero radio", "code_information": [{"code": "G0251", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Linear acc stereo radsur com", "code_information": [{"code": "G0173", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lipid panel res doc rev", "code_information": [{"code": "G8767", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lipid pn results", "code_information": [{"code": "G8593", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lipid profile not perf", "code_information": [{"code": "G8728", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lipid profile not perform", "code_information": [{"code": "G8769", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Lipid profile perf doc", "code_information": [{"code": "G8725", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Liver And/Or Bone Marrow Biopsy With Removal Of Spleen And Lymph Nodes", "code_information": [{"code": "49220", "type": "CPT"}], "standard_charges": [{"minimum": 893.72, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 893.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 893.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 893.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 893.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 893.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Low-density lipoprotein receptor-related protein 4 (LRP4), antibody identification by immunofluorescence, using live cells, reported as positive or negative", "code_information": [{"code": "546U", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, 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"methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lower respiratory tract infectious agent detection, 18 bacteria, 8 viruses, and 7 antimicrobial-resistance genes, amplified probe technique, including reverse transcription for RNA targets, each analyte reported as detected or not detected with semiquanti", "code_information": [{"code": "528U", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Loxapine, inhalation powder", 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"standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYS SKELETAL MUSC", "code_information": [{"code": "88355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 937.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 937.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 343.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 343.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 343.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 343.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 343.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAGIC MOUTHWASH CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315541", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MAGIC MOUTHWASH CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315541", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MAGNESIUM", "code_information": [{"code": "83735", "type": "CPT"}, {"code": "4103735", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.16, "gross_charge": 143.0, "discounted_cash": 107.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.16, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNESIUM", "code_information": [{"code": "83735", "type": "CPT"}, {"code": "7253735", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.16, "gross_charge": 143.0, "discounted_cash": 107.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.16, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNESIUM/2", "code_information": [{"code": "83735", "type": "CPT"}, {"code": "7253737", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.16, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": 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"HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNETIC IMAGE BONE MARROW", "code_information": [{"code": "77084", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 925.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 925.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 656.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 356.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 396.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 396.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 396.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 396.28, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 656.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 656.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 656.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 656.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNETIC SOURCE IMAGING", "code_information": [{"code": "S8035", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAINT AWAKNESS TEST", "code_information": [{"code": "95805", "type": "CPT"}, {"code": "6912114", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2388.12, "gross_charge": 11012.0, "discounted_cash": 8259.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2388.12, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 635.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 151780.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 101044.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 159708.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 84144.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 106322.01, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76041.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 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"plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 38371.55, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 88119.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 148804.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 187514.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "165", "type": "MS-DRG"}], "standard_charges": [{"minimum": 46872.18, "maximum": 154223.98, "estimated_discounted_cash": 100961.7, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 102512.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE 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"plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 66413.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 83690.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "708", "type": "MS-DRG"}], "standard_charges": [{"minimum": 50938.51, "maximum": 64189.39, "estimated_discounted_cash": 156412.48, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50938.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 64189.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC", "code_information": [{"code": "507", "type": "MS-DRG"}], "standard_charges": [{"minimum": 59976.09, "maximum": 75577.97, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 59976.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 75577.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "508", "type": "MS-DRG"}], "standard_charges": [{"minimum": 50281.11, "maximum": 63360.98, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50281.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63360.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [{"code": "595", "type": "MS-DRG"}], "standard_charges": [{"minimum": 70411.48, "maximum": 88727.97, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 70411.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 88727.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [{"code": "596", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35941.17, "maximum": 45290.72, "estimated_discounted_cash": 49074.6, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35941.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45290.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [{"code": "330", "type": "MS-DRG"}], "standard_charges": [{"minimum": 79591.83, "maximum": 100296.45, "estimated_discounted_cash": 170491.49, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 79591.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 100296.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [{"code": "329", "type": "MS-DRG"}], "standard_charges": [{"minimum": 152612.99, "maximum": 192312.96, "estimated_discounted_cash": 240479.7, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 152612.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 192312.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "331", "type": "MS-DRG"}], "standard_charges": [{"minimum": 55875.65, "maximum": 70410.85, "estimated_discounted_cash": 142042.2, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55875.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 70410.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [{"code": "506", "type": "MS-DRG"}], "standard_charges": [{"minimum": 44796.14, "maximum": 56449.18, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44796.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 56449.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1239.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1239.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1239.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1239.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1239.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1245.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1245.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1245.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1245.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1245.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33762", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1294.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1294.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1294.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1294.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1294.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33766", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1374.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1374.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1374.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1374.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1374.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33767", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1438.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1438.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1438.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1438.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1438.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT & GRAFT", "code_information": [{"code": "33764", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1297.8, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1297.8, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1297.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1297.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1297.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAKENA, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1726", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.75, "maximum": 23.05, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALARIA ANTIBODY", "code_information": [{"code": "86750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALE CONDOM", "code_information": [{"code": "A4267", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MALE SLING PROCEDURE", "code_information": [{"code": "53440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 40098.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4775.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total 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"maximum": 140.28, "gross_charge": 668.0, "discounted_cash": 501.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 140.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATE FINGER W/ANESTH", "code_information": [{"code": "26340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATE WRIST W/ANESTHES", "code_information": [{"code": "25259", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF HIP JOINT", "code_information": [{"code": "27275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF SPINE", "code_information": [{"code": "22505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANUAL CELL COUNT EACH", "code_information": [{"code": "85032", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL DIFF WBC COUNT B-COAT", "code_information": [{"code": "85009", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 18.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL RETICULOCYTE COUNT", "code_information": [{"code": "85044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.94, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL THERAPY 1/> REGIONS", "code_information": [{"code": "97140", "type": "CPT"}], "standard_charges": [{"minimum": 21.61, "maximum": 64.34, "estimated_discounted_cash": 554.26, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 57.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 64.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 64.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 64.34, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAPCP DEMO COMMUNITY", "code_information": [{"code": "G9152", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAPCP DEMO PHYSICIAN", "code_information": [{"code": "G9153", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAPCP DEMO STATE", "code_information": [{"code": "G9151", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAPLE SYRUP UR DS MNTR QUAN", "code_information": [{"code": "381U", "type": "CPT"}], "standard_charges": [{"minimum": 44.12, "maximum": 44.12, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARIJUANA METABOLITE", "code_information": [{"code": "80349", "type": "CPT"}, {"code": "7252542", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 173.0, "discounted_cash": 129.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION ODON CYST", "code_information": [{"code": "D7509", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASS SPEC TNDM MS NES/2", "code_information": [{"code": "83789", "type": "CPT"}, {"code": "7253783", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.09, "gross_charge": 138.0, "discounted_cash": 103.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASS SPEC TNDM MS NES/6", "code_information": [{"code": "83789", "type": "CPT"}, {"code": "7258378", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.09, "gross_charge": 293.0, "discounted_cash": 219.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASSAGE THERAPY", "code_information": [{"code": "97124", "type": "CPT"}], "standard_charges": [{"minimum": 18.73, "maximum": 66.96, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 60.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 58.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 66.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 66.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 66.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST MOD RAD", "code_information": [{"code": "19307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1067.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1067.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1067.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1067.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1067.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAST RAD URBAN TYPE", "code_information": [{"code": "19306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1062.12, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1062.12, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1062.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1062.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1062.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAST RADICAL", "code_information": [{"code": "19305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAST SIMPLE COMPLETE", "code_information": [{"code": "19303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 26015.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITH CC/MCC", "code_information": [{"code": "582", "type": "MS-DRG"}], "standard_charges": [{"minimum": 63966.97, "maximum": 80607.02, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63966.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80607.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "583", "type": "MS-DRG"}], "standard_charges": [{"minimum": 57253.53, "maximum": 633651.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 570280.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 333065.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 287828.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 451672.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 302862.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 600066.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 350461.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 475264.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 319812.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 501863.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 370076.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 633651.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 501863.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 319812.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 370076.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 633651.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 370076.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 633651.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 319812.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 501863.88, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 316477.58, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 427631.54, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 523901.57, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 253501.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 57253.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 72147.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTERS TWO STEP", "code_information": [{"code": "S3904", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY", "code_information": [{"code": "69501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY", "code_information": [{"code": "69502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOIDS < 3V/SIDE", "code_information": [{"code": "70120", "type": "CPT"}, {"code": "4900120", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 240.03, "gross_charge": 1143.0, "discounted_cash": 857.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 240.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.78, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOIDS < 3V/SIDE", "code_information": [{"code": "70120", "type": "CPT"}, {"code": "5010120", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 240.03, "gross_charge": 1143.0, "discounted_cash": 857.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 240.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 39.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOIDS BI 3VWS PR SIDE", "code_information": [{"code": "70130", "type": "CPT"}, {"code": "4900130", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 298.62, "gross_charge": 1422.0, "discounted_cash": 1066.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 298.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 111.65, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOIDS BI 3VWS PR SIDE", "code_information": [{"code": "70130", "type": "CPT"}, {"code": "5010130", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 298.62, "gross_charge": 1422.0, "discounted_cash": 1066.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 298.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 111.65, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOTOMY EXPL DRG ABSC DP", "code_information": [{"code": "19020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MATRISTEM MICROMATRIX", "code_information": [{"code": "Q4118", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MATRIX FLEX MAGNETOS FLEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4528.86, "maximum": 4528.86, "gross_charge": 21566.0, "discounted_cash": 16174.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4528.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRL FOR VOCAL CORD", "code_information": [{"code": "C1878", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MATRX BN ALLOSYNC DBM GEL/PUTT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4013648", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 958.23, "maximum": 958.23, "gross_charge": 4563.0, "discounted_cash": 3422.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 958.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX BN CELL VIVIGN 1CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132976", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 197.61, "maximum": 197.61, "gross_charge": 941.0, "discounted_cash": 705.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 197.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX BN FIBERGRFT BG SML 3CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4023941", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1242.78, "maximum": 1242.78, "gross_charge": 5918.0, "discounted_cash": 4438.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1242.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX BN FIBERGRFT MED 6.25CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4028528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5046.09, "maximum": 5046.09, "gross_charge": 24029.0, "discounted_cash": 18021.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 5046.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX BN FIBRGRFT BG LG 12.5CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4023929", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4669.56, "maximum": 4669.56, "gross_charge": 22236.0, "discounted_cash": 16677.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4669.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX CARTILAG EXTRACELL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4023891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1173.48, "maximum": 1173.48, "gross_charge": 5588.0, "discounted_cash": 4191.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1173.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX COLLAGEN XENMATRIX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4023888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 22067.01, "maximum": 22067.01, "gross_charge": 105081.0, "discounted_cash": 78810.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 22067.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX DURAL DURAGEN PLUS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4023922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1172.22, "maximum": 1172.22, "gross_charge": 5582.0, "discounted_cash": 4186.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1172.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX TISS CONEXA 6X6CM", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4023905", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 4026.33, "maximum": 4026.33, "gross_charge": 19173.0, "discounted_cash": 14379.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4026.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX TISS CONEXA 6X6CM", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4023905", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4026.33, "maximum": 4026.33, "gross_charge": 19173.0, "discounted_cash": 14379.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4026.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX WND FLOWABLE 1CC", "code_information": [{"code": "Q4114", "type": "HCPCS"}, {"code": "4023910", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2166.99, "maximum": 2166.99, "gross_charge": 10319.0, "discounted_cash": 7739.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2166.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX WND FLOWABLE 1CC", "code_information": [{"code": "Q4114", "type": "HCPCS"}, {"code": "4023910", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2166.99, "maximum": 2166.99, "gross_charge": 10319.0, "discounted_cash": 7739.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2166.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAX VOLUNTRY VENTILATION", "code_information": [{"code": "94200", "type": "CPT"}, {"code": "5504200", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 26.29, "maximum": 165.85, "gross_charge": 330.0, "discounted_cash": 247.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"facility"}]}, {"description": "MAXILLA OR MANDIBLE RESECTIO", "code_information": [{"code": "D7490", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAXILLARY SINUSOTOMY", "code_information": [{"code": "D7560", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAXILLOFACIAL FIXATION", "code_information": [{"code": "21100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MC PERF SPECT WM EF MULT", "code_information": [{"code": "78452", "type": "CPT"}, {"code": "5204301", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2243.43, "gross_charge": 10683.0, "discounted_cash": 8012.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2243.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1221.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1902.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MC PERF SPECT WM EF SNGL", "code_information": [{"code": "78451", "type": "CPT"}, {"code": "5204300", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2113.02, "gross_charge": 5071.0, "discounted_cash": 3803.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1064.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 834.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1902.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MC PERF WM EF MULTI STDY", "code_information": [{"code": "78454", "type": "CPT"}, {"code": "5204303", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2113.02, "gross_charge": 7662.0, "discounted_cash": 5746.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1609.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1077.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1902.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF 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schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 748.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1902.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCATH FINECROSS", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "4033046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 538.86, "maximum": 538.86, "gross_charge": 2566.0, "discounted_cash": 1924.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 538.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCATH RENEGADE HI FLO", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "4033041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 632.52, "maximum": 632.52, "gross_charge": 3012.0, "discounted_cash": 2259.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 632.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCCD, HOME MONITORING", "code_information": [{"code": "G9006", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, INITIAL RATE", "code_information": [{"code": "G9001", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ HI, INITIAL", "code_information": [{"code": "G9003", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ LO, INITIAL", "code_information": [{"code": "G9004", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ, LEVEL 3", "code_information": [{"code": "G9009", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ, LEVEL 4", "code_information": [{"code": "G9010", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ, LEVEL 5", "code_information": [{"code": "G9011", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ, MAINTENANCE", "code_information": [{"code": "G9005", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD, SCH TEAM CONF", "code_information": [{"code": "G9007", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD,MAINTENANCE RATE", "code_information": [{"code": "G9002", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCCD,PHYS COOR-CARE OVRSGHT", "code_information": [{"code": "G9008", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MCHNL FRAGILITY RBC PRFLG", "code_information": [{"code": "123U", "type": "CPT"}], "standard_charges": [{"minimum": 357.63, "maximum": 357.63, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 357.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 357.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCOLN1 COMMON VARIANT", "code_information": [{"code": "81290", "type": "CPT"}, {"code": "7251290", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 39.31, "maximum": 39.31, "gross_charge": 679.0, "discounted_cash": 509.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY DX", "code_information": [{"code": "29900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY SURG", "code_information": [{"code": "29901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY SURG", "code_information": [{"code": "29902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MD CERTIFICATION HHA PATIENT", "code_information": [{"code": "G0180", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD DOCUMENT VISIT BY NPP", "code_information": [{"code": "G0454", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD HOME VISIT OUTSIDE CAP", "code_information": [{"code": "S0273", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD INR TEST REVIE INTER MGMT", "code_information": [{"code": "G0250", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.1, "maximum": 20.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD RECERTIFICATION HHA PT", "code_information": [{"code": "G0179", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD SERVICE REQUIRED FOR PMD", "code_information": [{"code": "G0372", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD/OTH EVAL ACUT KID NO ESRD", "code_information": [{"code": "G0492", "type": "HCPCS"}], "standard_charges": [{"minimum": 490.81, "maximum": 561.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 505.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 490.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 561.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 561.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 561.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MDFC FLAP W/PRSRV VASC PEDCL", "code_information": [{"code": "15730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MDI DEMO AND/OR EVAL", "code_information": [{"code": "94664", "type": "CPT"}, {"code": "5502100", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 17.77, "maximum": 298.43, "gross_charge": 1034.0, "discounted_cash": 775.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 260.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MDI TREATMENT", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "5502105", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 16.25, "maximum": 298.43, "gross_charge": 615.0, "discounted_cash": 461.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 260.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEALS FOR CLINICAL TRIAL PAR", "code_information": [{"code": "S9996", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEALS PER DIEM", "code_information": [{"code": "S9977", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEAS LUNG VOL THRU 2 YRS", "code_information": [{"code": "94013", "type": "CPT"}], "standard_charges": [{"minimum": 620.07, "maximum": 709.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE KIDNEY PRESSURE", "code_information": [{"code": "50396", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEASURE URETER PRESSURE", "code_information": [{"code": "50686", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEASURE VENOUS PRESSURE", "code_information": [{"code": "93770", "type": "CPT"}], "standard_charges": [{"minimum": 8.36, "maximum": 8.36, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.36, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEAT FIBERS FECES", "code_information": [{"code": "89160", "type": "CPT"}, {"code": "7258916", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.8, "gross_charge": 102.0, "discounted_cash": 76.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 18.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECH CHEST WALL OSCILL", "code_information": [{"code": "94669", "type": "CPT"}, {"code": "5504670", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 463.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECH REMVL OBSTRTN GTUBE", "code_information": [{"code": "4909460", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3350.0, "discounted_cash": 2512.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MECH REMVL OBSTRTN GTUBE", "code_information": [{"code": "4919460", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3350.0, "discounted_cash": 2512.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MECH THRMBCTMY VN RPEAT", "code_information": [{"code": "4914106", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20774.0, "discounted_cash": 15580.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MECHANICAL TRACTION THERAPY", "code_information": [{"code": "97012", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 33.93, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECLIZINE 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306968", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MECLIZINE 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306968", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MECLIZINE TAB 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306972", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MECLIZINE TAB 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306972", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MECP2 FULL GENE ANALYSIS", "code_information": [{"code": "234U", "type": "CPT"}], "standard_charges": [{"minimum": 527.87, "maximum": 527.87, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 527.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 527.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE DUP/DELET VARIANT", "code_information": [{"code": "81304", "type": "CPT"}], "standard_charges": [{"minimum": 150.0, "maximum": 150.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE FULL SEQ", "code_information": [{"code": "81302", "type": "CPT"}], "standard_charges": [{"minimum": 527.87, "maximum": 527.87, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": 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"AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED NUTRTN GRP EA 30 MIN", "code_information": [{"code": "97804", "type": "CPT"}, {"code": "3530038", "type": "CDM"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 14.82, "maximum": 36.56, "gross_charge": 269.0, "discounted_cash": 201.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36.56, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED NUTRTN GRP EA 30 MIN", "code_information": [{"code": "97804", "type": "CPT"}, {"code": "6570038", "type": "CDM"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 14.82, "maximum": 36.56, "gross_charge": 269.0, "discounted_cash": 201.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36.56, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED NUTRTN TH INIT 15MIN", "code_information": [{"code": "97802", "type": "CPT"}, {"code": "3530036", "type": "CDM"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 29.47, "maximum": 78.03, "gross_charge": 249.0, "discounted_cash": 186.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 70.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 68.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 78.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 78.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 78.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED NUTRTN TH INIT 15MIN", "code_information": [{"code": "97802", "type": "CPT"}, {"code": "6570036", "type": "CDM"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 29.47, "maximum": 78.03, "gross_charge": 249.0, "discounted_cash": 186.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 70.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 68.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 78.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 78.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 78.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED NUTRTN TH REEVAL15MN", "code_information": [{"code": "97803", "type": "CPT"}, {"code": "3530037", "type": "CDM"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 26.28, "maximum": 66.66, "gross_charge": 231.0, "discounted_cash": 173.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 58.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 66.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 66.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 66.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED NUTRTN TH REEVAL15MN", "code_information": [{"code": "97803", "type": "CPT"}, {"code": "6570037", "type": "CDM"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 26.28, "maximum": 66.66, "gross_charge": 231.0, "discounted_cash": 173.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 58.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 66.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 66.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 66.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED PHYSIC DOS EVAL RAD EXPS", "code_information": [{"code": "76145", "type": "CPT"}], "standard_charges": [{"minimum": 126.87, "maximum": 218.48, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 196.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 218.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 218.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 218.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 218.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 126.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 126.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED REAS PT, PN, NOT DOC", "code_information": [{"code": "G8722", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED RECORD COPY ADMIN", "code_information": [{"code": "S9981", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED RECORD COPY PER PAGE", "code_information": [{"code": "S9982", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MED REMINDER SERV PER MONTH", "code_information": [{"code": "S5185", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW 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"standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED SERVICE OUT OF OFFICE", "code_information": [{"code": "99056", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "1990008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7259.0, "discounted_cash": 5444.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2120008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7259.0, "discounted_cash": 5444.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2150008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7259.0, "discounted_cash": 5444.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2160008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7259.0, "discounted_cash": 5444.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2310008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7259.0, "discounted_cash": 5444.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2350008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7259.0, "discounted_cash": 5444.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDIASTINOSCPY W/LMPH NOD BX", "code_information": [{"code": "39402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 24845.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDIASTINOSCPY W/MEDSTNL BX", "code_information": [{"code": "39401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 33590.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL BACK PROBLEMS WITH MCC", "code_information": [{"code": "551", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 70126.35, "estimated_discounted_cash": 81151.09, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55649.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 70126.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [{"code": "552", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 40219.83, "estimated_discounted_cash": 54814.02, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31917.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40219.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL CONFERENCE BY PHYSIC", "code_information": [{"code": "S0220", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL CONFERENCE, 60 MIN", "code_information": [{"code": "S0221", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL FOOD ORAL 100% NUTR", "code_information": [{"code": "S9433", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL FOODS FOR INBORN ERR", "code_information": [{"code": "S9435", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME LEVEL 1", "code_information": [{"code": "G9148", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME LEVEL II", "code_information": [{"code": "G9149", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME LEVEL III", "code_information": [{"code": "G9150", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME, INITIAL PLAN", "code_information": [{"code": "S0280", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME, MAINTENANCE", "code_information": [{"code": "S0281", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL REASON FOR NO BETA", "code_information": [{"code": "G9190", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDICAL SERVICES AFTER HRS", "code_information": [{"code": "99050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL SUPPLIES AND EQUIPME", "code_information": [{"code": "S9061", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDISKIN", "code_information": [{"code": "Q4135", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDROXYPROGEST 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307026", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDROXYPROGEST 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307026", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDROXYPROGEST 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307022", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDROXYPROGEST 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307022", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDRSN >1 SINUS CT W 90D DX", "code_information": [{"code": "G9353", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MEDRSN NO PT CATEGORY", "code_information": [{"code": "G9292", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed 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"drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5315568", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MEGESTROL40MG/ML 10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5315568", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MELATONIN 3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307080", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MELATONIN 3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307080", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MELPHALAN ORAL 2 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8600", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.4, "maximum": 10.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEMANTINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307111", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MEMANTINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307111", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MEMBRN DURA SUBST ABSORB", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4023988", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1111.53, "maximum": 1111.53, "gross_charge": 5293.0, "discounted_cash": 3969.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1111.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEMODERM/DERMA/TRANZ/INTEGUP", "code_information": [{"code": "Q4126", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MENACWY-TT MENB-FHBP VACC IM", "code_information": [{"code": "90623", "type": "CPT"}], "standard_charges": [{"minimum": 255.85, "maximum": 284.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 255.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 284.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 284.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 284.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 284.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENINGO VAC IM RCMB LIPO 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248.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENINGO VAC IM RCMB LIPO PFSIJ", "code_information": [{"code": "90621", "type": "CPT"}, {"code": "5322054", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 223.77, "maximum": 248.63, "gross_charge": 869.0, "discounted_cash": 651.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 223.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 248.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 248.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 248.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 248.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENINGOCOCCAL B OMV VAC PFSIJ", "code_information": [{"code": "90620", "type": "CPT"}, {"code": "5322056", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 255.96, "maximum": 284.4, "gross_charge": 819.0, "discounted_cash": 614.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 255.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 284.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 284.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 284.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 284.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENINGOCOCCAL B OMV VAC PFSIJ", "code_information": [{"code": "90620", "type": "CPT"}, {"code": "5322056", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 255.96, "maximum": 284.4, "gross_charge": 819.0, "discounted_cash": 614.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 255.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 284.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS 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199.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 199.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 199.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 199.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENINGOCOCCAL VAC IM IJ", "code_information": [{"code": "90734", "type": "CPT"}, {"code": "5322059", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 179.96, "maximum": 199.95, "gross_charge": 692.0, "discounted_cash": 519.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 179.96, "methodology": "fee 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"gross_charge": 632.0, "discounted_cash": 474.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 185.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 206.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 206.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 206.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 206.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENISCAL TRNSPL KNEE W/SCPE", "code_information": [{"code": "29868", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1684.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1684.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1684.74, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC", "code_information": [{"code": "760", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3510.54, "maximum": 67561.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36254.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25911.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS 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"methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10653.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6352.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4540.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3693.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 27264.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22181.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 63980.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 40283.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3900.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 67561.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6708.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11251.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4794.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23423.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28790.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6708.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4794.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11251.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28790.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23423.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 67561.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40283.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3900.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4794.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11251.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6708.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 67561.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28790.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3900.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40283.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23423.32, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13144.93, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 33617.67, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 30319.7, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 17391.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33451.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42152.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "761", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18941.74, "maximum": 23869.15, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18941.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23869.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MERCAPTOPURINE", "code_information": [{"code": "80375", "type": "CPT"}, {"code": "7250370", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 436.0, "discounted_cash": 327.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MERCAPTOPURINE 50 MG", "code_information": [{"code": "S0108", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.34, "maximum": 3.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for 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"type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5307276", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MERCAPTOPURINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5307276", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MERCURY QUANTITATIVE", "code_information": [{"code": "83825", "type": "CPT"}, {"code": "7253825", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.93, "gross_charge": 426.0, "discounted_cash": 319.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.72, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESALAMINE 250MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307281", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MESALAMINE 250MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307281", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MESALAMINE 400MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, 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"code_information": [{"code": "87190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.84, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 28.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE MLC", "code_information": [{"code": "87187", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 52.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 40.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROCAPILLARY TUBE SEALANT", "code_information": [{"code": "A4652", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MICRODISSECTION LASER", "code_information": [{"code": "88380", "type": "CPT"}], "standard_charges": [{"minimum": 78.86, "maximum": 179.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 179.89, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 179.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 179.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 179.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 179.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 78.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 78.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICRODISSECTION MANUAL", "code_information": [{"code": "88381", "type": "CPT"}, {"code": "7258543", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 180.05, "maximum": 482.0, "gross_charge": 482.0, "discounted_cash": 361.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 482.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 248.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 248.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 248.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 248.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 248.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 180.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 180.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROFLUID ANALY TEARS", "code_information": [{"code": "83861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 84.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 84.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROHEMATOCRIT SPUN", "code_information": [{"code": "85013", "type": "CPT"}, {"code": "4105054", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 12.08, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3.31, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROSATELLITE INSTABILITY", "code_information": [{"code": "81301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1478.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1478.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 348.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 348.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROSOMAL ANTIBODY EA", "code_information": [{"code": "86376", "type": "CPT"}, {"code": "7255559", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.2, "gross_charge": 84.0, "discounted_cash": 63.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROSOMAL ANTIBODY EA/2", "code_information": [{"code": "86376", "type": "CPT"}, {"code": "7256374", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.2, "gross_charge": 347.0, "discounted_cash": 260.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROSURG EPI SPERM ASP", "code_information": [{"code": "S4028", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROSURGERY ADD-ON", "code_information": [{"code": "69990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 215.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 215.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 215.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 215.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 215.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICROVOLT T-WAVE ASSESS", "code_information": [{"code": "93025", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 295.39, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 295.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 295.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 295.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 295.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 295.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROWAVE BRONCH, 3D, EBUS", "code_information": [{"code": "C9751", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MIDAZOLAM 10MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327730", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MIDAZOLAM 10MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327730", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MIDLINE INSERTION 3+YRS", "code_information": [{"code": "4916411", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MIDLINE INSERTION 3+YRS", "code_information": [{"code": "6296410", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MIDODRINE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307841", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MIDODRINE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307841", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MIDODRINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307842", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MIDODRINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307842", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MIFEPRISTONE, ORAL, 200 MG", "code_information": [{"code": "S0190", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.77, "maximum": 40.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2205", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2206", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2207", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2208", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2209", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINOCYCLINE 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307858", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MINOCYCLINE 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307858", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MINOCYCLINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2265", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.66, "maximum": 2.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.95, 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"standard_charge_dollar": 30771.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18613.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9423.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13328.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14074.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9950.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19655.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32494.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19655.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9950.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14074.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32494.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19655.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9950.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14074.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32494.06, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7383.91, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 21743.4, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10452.28, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5610.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50473.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19139.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 35986.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9843.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13498.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14254.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38000.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10394.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 20211.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 20211.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10394.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38000.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14254.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14254.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20211.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38000.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10394.94, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 20835.42, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8148.39, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 14968.73, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11810.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 101647.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 128090.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINOR BLADDER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "664", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34759.17, "maximum": 43801.25, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 34759.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 43801.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINOR SKIN DISORDERS WITH MCC", "code_information": [{"code": "606", "type": "MS-DRG"}], "standard_charges": [{"minimum": 50241.27, "maximum": 63310.77, "estimated_discounted_cash": 59628.21, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50241.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63310.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINOR SKIN DISORDERS WITHOUT MCC", "code_information": [{"code": "607", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30094.29, "maximum": 186634.75, "estimated_discounted_cash": 30607.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 41880.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 130671.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH 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"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ I-ARTIC RX DEV", "code_information": [{"code": "20704", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ IMED RX DEV", "code_information": [{"code": "20702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNPJ ANES SHO JT FIXJ APRATS", "code_information": [{"code": "23700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNPJ ELBOW UNDER ANES", "code_information": [{"code": "24300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNPJ OF TMJ W/ANESTH", "code_information": [{"code": "21073", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNT SUBS TX FOR CHANGE DX", "code_information": [{"code": "G0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.49, "maximum": 61.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 55.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 53.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNTR CDVR DON LNG 1ST 2 HRS", "code_information": [{"code": "495T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNTR CDVR DON LNG EA ADDL HR", "code_information": [{"code": "496T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOBILIZATION OF COLON", "code_information": [{"code": "44139", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOD OR SEVERE OSA", "code_information": [{"code": "G8846", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOD SOLID FOOD SUPPL", "code_information": [{"code": "S9434", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MODAFINIL 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307883", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MODAFINIL 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307883", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MOG-IGG1 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86363", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE H/N/HF/G", "code_information": [{"code": "17311", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE T/A/L", "code_information": [{"code": "17313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE", "code_information": [{"code": "17312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE T/A/L", "code_information": [{"code": "17314", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 162.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS SURG ADDL BLOCK", "code_information": [{"code": "17315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOLEC CYTOGEN CHRM 10-30", "code_information": [{"code": "88273", "type": "CPT"}, {"code": "7258254", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 163.85, "gross_charge": 718.0, "discounted_cash": 538.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 163.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.89, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 44.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 44.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 34.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLEC CYTOGEN INTPHS 100-300", "code_information": [{"code": "88275", "type": "CPT"}, {"code": "7258201", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 204.8, "gross_charge": 426.0, "discounted_cash": 319.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 204.8, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 56.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 56.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 56.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 56.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 56.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 51.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 51.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLEC CYTOGEN INTPHS 25-99", "code_information": [{"code": "88274", "type": "CPT"}, {"code": "7270160", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 177.5, "gross_charge": 768.0, "discounted_cash": 576.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 177.5, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.63, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLEC FLUOR IMG SUS NEV 1ST", "code_information": [{"code": "700T", "type": "CPT"}], "standard_charges": [{"minimum": 35.58, "maximum": 35.58, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLEC FLUOR IMG SUS NEV EA", "code_information": [{"code": "701T", "type": "CPT"}], "standard_charges": [{"minimum": 10.51, "maximum": 10.51, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATH LEVEL 1", "code_information": [{"code": "81400", "type": "CPT"}, {"code": "7140024", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 63.96, "maximum": 63.96, "gross_charge": 698.0, "discounted_cash": 523.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATH LEVEL 1", "code_information": [{"code": "81400", "type": "CPT"}, {"code": "7251400", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 63.96, "maximum": 63.96, "gross_charge": 698.0, "discounted_cash": 523.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATH LEVEL 2/3", "code_information": [{"code": "81401", "type": "CPT"}, {"code": "7251401", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "gross_charge": 1128.0, "discounted_cash": 846.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATH LEVEL 3", "code_information": [{"code": "81402", "type": "CPT"}, {"code": "7251402", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 150.33, "maximum": 150.33, "gross_charge": 1870.0, "discounted_cash": 1402.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 150.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 150.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATH LEVEL 4/3", "code_information": [{"code": "81403", "type": "CPT"}, {"code": "7259214", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 185.2, "maximum": 185.2, "gross_charge": 1396.0, "discounted_cash": 1047.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATH LEVEL 5", "code_information": [{"code": "81404", "type": "CPT"}, {"code": "7251404", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "gross_charge": 1792.0, "discounted_cash": 1344.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATH LEVEL 6", "code_information": [{"code": "81405", "type": "CPT"}, {"code": "7251405", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 301.35, "maximum": 301.35, "gross_charge": 3543.0, "discounted_cash": 2657.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATH LEVEL 7", "code_information": [{"code": "81406", "type": "CPT"}, {"code": "7251406", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 282.88, "maximum": 282.88, "gross_charge": 6583.0, "discounted_cash": 4937.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATH LEVEL 8", "code_information": [{"code": "81407", "type": "CPT"}, {"code": "7251407", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 846.27, "maximum": 846.27, "gross_charge": 13644.0, "discounted_cash": 10233.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 846.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 846.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATH LEVEL 9", "code_information": [{"code": "81408", "type": "CPT"}, {"code": "7270176", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 2000.0, "maximum": 2000.0, "gross_charge": 24580.0, "discounted_cash": 18435.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2000.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2000.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATHOLOGY INTERPR", "code_information": [{"code": "G0452", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.14, "maximum": 3.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLECULR CYTO DNA PRB EA", "code_information": [{"code": "88271", "type": "CPT"}, {"code": "7258832", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 109.24, "gross_charge": 400.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 109.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOMETASONE SINUS SINUVA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7402", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.22, "maximum": 11.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MONIT STORE CRYO EMBRYO 30 D", "code_information": [{"code": "S4040", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and 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"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA, W/O&W/DYE, SPINAL CANAL", "code_information": [{"code": "C8933", "type": "HCPCS"}], "standard_charges": [{"minimum": 368.12, "maximum": 368.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRA, W/O&W/DYE, UPPER EXTR", "code_information": [{"code": "C8936", "type": "HCPCS"}], "standard_charges": [{"minimum": 368.12, "maximum": 368.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRCP", "code_information": [{"code": "S8037", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 837.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 754.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 837.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 837.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 837.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 837.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRGFUS STRTCTC LES ABLTJ", "code_information": [{"code": "398T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI ABDOMEN W/O CM", "code_information": [{"code": "74181", "type": "CPT"}, {"code": "5251075", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1599.78, "gross_charge": 7618.0, "discounted_cash": 5713.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1599.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1154.06, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 620.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 620.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 620.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 620.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 620.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI ABDOMEN WO/W CM", "code_information": [{"code": "74183", "type": "CPT"}, {"code": "5251000", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2419.62, "gross_charge": 11522.0, "discounted_cash": 8641.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2419.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1650.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1134.63, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1134.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1134.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1134.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1134.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 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{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 671.9, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 671.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 671.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 671.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 671.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN W/O DYE", "code_information": [{"code": "70557", "type": "CPT"}], "standard_charges": [{"minimum": 482.89, "maximum": 855.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 769.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 855.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 855.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS 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189.63, "gross_charge": 903.0, "discounted_cash": 677.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 189.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH RESORB FULL SCAFFOLD", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3083.64, "maximum": 3083.64, "gross_charge": 14684.0, "discounted_cash": 11013.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3083.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH RESTORELLE Y", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1685.46, "maximum": 1685.46, "gross_charge": 8026.0, "discounted_cash": 6019.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1685.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH VENTRALEX W STRP", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 413.07, "maximum": 413.07, "gross_charge": 1967.0, "discounted_cash": 1475.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 413.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH VENTRALIGHT POS SYS", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3080.49, "maximum": 3080.49, "gross_charge": 14669.0, "discounted_cash": 11001.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3080.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH2 FULL SEQUENCE ANLS", "code_information": [{"code": "81295", "type": "CPT"}, {"code": "4100343", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 567.9, "gross_charge": 855.0, "discounted_cash": 641.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 567.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 381.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 381.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH2 GENE DUP/DELETE VARIANT", "code_information": [{"code": "81297", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 567.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 567.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 213.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 213.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH2 GENE KNOWN VARIANTS", "code_information": [{"code": "81296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 484.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 484.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH2 MRNA SEQ ALYS", "code_information": [{"code": "159U", "type": "CPT"}], "standard_charges": [{"minimum": 282.88, "maximum": 282.88, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH6 FULL SEQUENCE ANLS", "code_information": [{"code": "81298", "type": "CPT"}, {"code": "4100344", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1077.48, "gross_charge": 1094.0, "discounted_cash": 820.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1077.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 641.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 641.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH6 GENE DUP/DELETE VARIANT", "code_information": [{"code": "81300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 605.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 605.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH6 GENE KNOWN VARIANTS", "code_information": [{"code": "81299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 603.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 603.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH6 MRNA SEQ ALYS", "code_information": [{"code": "160U", "type": "CPT"}], "standard_charges": [{"minimum": 282.88, "maximum": 282.88, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MT BONE GRAFT MICROVASC", "code_information": [{"code": "20957", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2459.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2459.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2459.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2459.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2459.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MTB AMP PROBE", "code_information": [{"code": "87556", "type": "CPT"}, {"code": "7257556", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "gross_charge": 393.0, "discounted_cash": 294.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTB RIFAMPIN RST AMP PRB TQ", "code_information": [{"code": "87564", "type": "CPT"}, {"code": "7250671", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 76.77, "maximum": 76.77, "gross_charge": 375.0, "discounted_cash": 281.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 76.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 76.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTHFR COMMON VARIANTS", "code_information": [{"code": "81291", "type": "CPT"}, {"code": "7259210", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 222.94, "gross_charge": 408.0, "discounted_cash": 306.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 222.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM ADDL 15 MIN", "code_information": [{"code": "99607", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM EST 15 MIN", "code_information": [{"code": "99606", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM NP 15 MIN", "code_information": [{"code": "99605", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUCIN SYNOVIAL FLUID(ROP", "code_information": [{"code": "83872", "type": "CPT"}, {"code": "4103872", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.89, "gross_charge": 84.0, "discounted_cash": 63.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 29.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUCOPOLYSAAC-ACID URN QN/2", "code_information": [{"code": "83864", "type": "CPT"}, {"code": "7253865", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 101.54, "gross_charge": 427.0, "discounted_cash": 320.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 101.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.82, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28.5, "methodology": "fee 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"code_information": [{"code": "86735", "type": "CPT"}, {"code": "7256738", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.54, "gross_charge": 520.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.54, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MURAMIDASE", "code_information": [{"code": "85549", "type": "CPT"}, {"code": "7255546", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 95.67, "gross_charge": 504.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 95.67, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.21, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSC MYOQ/FSCQ FLP H&N PEDCL", "code_information": [{"code": "15733", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSC/TDN TRANSFER UPR A/E 1", "code_information": [{"code": "24301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE BIOPSY SUPERFICIAL", "code_information": [{"code": "20200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 3 LIMBS", "code_information": [{"code": "95863", "type": "CPT"}], "standard_charges": [{"minimum": 152.12, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 152.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 152.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 152.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 152.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 152.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 4 LIMBS", "code_information": [{"code": "95864", "type": "CPT"}], "standard_charges": [{"minimum": 184.71, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 184.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 184.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 184.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 184.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 184.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST CRAN NERV UNILAT", "code_information": [{"code": "95867", "type": "CPT"}], "standard_charges": [{"minimum": 76.94, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 76.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 76.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 76.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 76.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 76.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST CRAN NERVE BILAT", "code_information": [{"code": "95868", "type": "CPT"}], "standard_charges": [{"minimum": 105.42, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 105.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 105.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 105.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 105.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 105.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST HEMIDIAPHRAGM", "code_information": [{"code": "95866", "type": "CPT"}], "standard_charges": [{"minimum": 93.09, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 93.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 93.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 93.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 93.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 93.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST LARYNX", "code_information": [{"code": "95865", "type": "CPT"}], "standard_charges": [{"minimum": 122.26, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST NONPARASPINAL", "code_information": [{"code": "95870", "type": "CPT"}], "standard_charges": [{"minimum": 45.13, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST ONE FIBER", "code_information": [{"code": "95872", "type": "CPT"}], "standard_charges": [{"minimum": 168.05, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 168.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 168.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 168.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 168.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 168.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TRANSFER SHOULDER/ARM", "code_information": [{"code": "23395", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE TRANSFERS", "code_information": [{"code": "23397", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT ARM", "code_information": [{"code": "15736", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT LEG", "code_information": [{"code": "15738", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT TRUNK", "code_information": [{"code": "15734", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SPECIFIC KINASE ANTB", "code_information": [{"code": "86366", "type": "CPT"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSK ANTIBODY", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "7250019", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.84, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.84, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSK ANTIBODY QUANT", "code_information": [{"code": "83519", "type": "CPT"}, {"code": "7250021", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.91, "gross_charge": 1540.0, "discounted_cash": 1155.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MVI ADC PEDI 50ML DR LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316627", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 42.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI ADC PEDI 50ML DR LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316627", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 42.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI RENAL FORMULA TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312435", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI RENAL FORMULA TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312435", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI VIT B COMPLEX TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303170", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI VIT B COMPLEX TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303170", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA AMP PROBE", "code_information": [{"code": "87551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 48.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 48.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA DIR PROBE", "code_information": [{"code": "87550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 102.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 102.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA QUANT", "code_information": [{"code": "87552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 218.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 218.45, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 59.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPHENOLATE200MG/ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", 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"plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPHENOLIC ACID/2", "code_information": [{"code": "80180", "type": "CPT"}, {"code": "7252546", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 88.84, "gross_charge": 337.0, "discounted_cash": 252.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 88.84, "methodology": "fee schedule"}, {"payer_name": 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"CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.56, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.56, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPLASMA AB/4", "code_information": [{"code": "86738", "type": "CPT"}, {"code": "7256740", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.56, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.56, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPLASMA AMP PROBE/2", "code_information": [{"code": "87581", "type": "CPT"}, {"code": "7253869", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "gross_charge": 366.0, "discounted_cash": 274.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPLASMA AMP PROBE/3", "code_information": [{"code": "87581", "type": "CPT"}, {"code": "7253876", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "gross_charge": 393.0, "discounted_cash": 294.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 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{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15890.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPEROXIDASE (MPO) AB", "code_information": [{"code": "83876", "type": "CPT"}, {"code": "7258352", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 173.34, "gross_charge": 191.0, "discounted_cash": 143.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 173.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 50.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [{"code": "827", "type": "MS-DRG"}], "standard_charges": [{"minimum": 76736.46, "maximum": 96698.3, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 76736.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 96698.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [{"code": "826", "type": "MS-DRG"}], "standard_charges": [{"minimum": 155312.32, "maximum": 195714.47, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 155312.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 195714.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "828", "type": "MS-DRG"}], "standard_charges": [{"minimum": 56569.57, "maximum": 71285.29, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 56569.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 71285.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC", "code_information": [{"code": "829", "type": "MS-DRG"}], "standard_charges": [{"minimum": 104918.32, "maximum": 132211.24, "estimated_discounted_cash": 149057.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 104918.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 132211.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "830", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49969.01, "maximum": 62967.69, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49969.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 62967.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCARDIUM IMG INFARCT", "code_information": [{"code": "78466", "type": "CPT"}, {"code": "5208406", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1308.3, "gross_charge": 6230.0, "discounted_cash": 4672.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1308.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 392.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 199.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 607.57, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 199.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 199.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 199.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 199.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 1 STD W/CT", "code_information": [{"code": "78429", "type": "CPT"}], "standard_charges": [{"minimum": 1480.34, "maximum": 2377.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2139.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2377.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2377.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2377.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2377.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 1STD RST/STRS", "code_information": [{"code": "78491", "type": "CPT"}], "standard_charges": [{"minimum": 1480.34, "maximum": 2364.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2128.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2364.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2364.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2364.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2364.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER", "code_information": [{"code": "78432", "type": "CPT"}], "standard_charges": [{"minimum": 2750.5, "maximum": 4531.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4078.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4531.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4531.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4531.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4531.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2750.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2750.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER CT", "code_information": [{"code": "78433", "type": "CPT"}], "standard_charges": [{"minimum": 2750.5, "maximum": 4531.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4078.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4531.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4531.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4531.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4531.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2750.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2750.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET MLT RST&STRS", "code_information": [{"code": "78492", "type": "CPT"}], "standard_charges": [{"minimum": 1480.34, "maximum": 2364.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2128.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2364.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2364.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2364.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2364.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET RST&STRS CT", "code_information": [{"code": "78431", "type": "CPT"}], "standard_charges": [{"minimum": 2250.5, "maximum": 3707.45, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3337.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3707.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3707.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3707.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3707.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2250.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2250.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET RST/STRS W/CT", "code_information": [{"code": "78430", "type": "CPT"}], "standard_charges": [{"minimum": 1480.34, "maximum": 2377.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2139.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2377.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2377.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2377.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2377.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET SINGLE STUDY", "code_information": [{"code": "78459", "type": "CPT"}], "standard_charges": [{"minimum": 1305.94, "maximum": 2113.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1902.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOGLOBIN", "code_information": [{"code": "83874", "type": "CPT"}, {"code": "4103873", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.85, "gross_charge": 189.0, "discounted_cash": 141.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.85, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOGLOBIN", "code_information": [{"code": "83874", "type": "CPT"}, {"code": "7253873", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.85, "gross_charge": 191.0, "discounted_cash": 143.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOGLOBIN/2", "code_information": [{"code": "83874", "type": "CPT"}, {"code": "7253875", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.85, "gross_charge": 74.0, "discounted_cash": 55.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOM COMPLEX", "code_information": [{"code": "58146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 51113.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1137.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1137.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1137.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1137.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1137.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOM METHOD", "code_information": [{"code": "58140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 895.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 895.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 895.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 895.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 895.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY VAG METHOD", "code_information": [{"code": "58145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", 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[{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Medical/Surgical Supplies And Devices Take-Home Supplies", "code_information": [{"code": "273", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Medrsn no ct rpt to reg", "code_information": [{"code": "G9325", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medrsn no dicom format doc", "code_information": [{"code": "G9328", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medrsn no dicom srch", "code_information": [{"code": "G9343", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medrsn no foot exam", "code_information": [{"code": "G9224", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medrsn no std nomenclature", "code_information": [{"code": "G9320", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Melatonin levels test, sleep study, 7 or 9 sample melatonin profile (cortisol optional), enzyme-linked immunosorbent assay (ELISA), saliva, screening/preliminary", "code_information": [{"code": "462U", "type": "CPT"}], "standard_charges": [{"minimum": 17.27, "maximum": 17.27, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Memory current status", "code_information": [{"code": "G9168", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Memory d/c status", "code_information": [{"code": "G9170", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Memory goal status", "code_information": [{"code": "G9169", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Meningococcal pentavalent vaccine, Men B-4C recombinant proteins and outer membrane vesicle and conjugated Men A, C, W, Y-diphtheria toxoid carrier, for intramuscular use", "code_information": [{"code": "90624", "type": "CPT"}], "standard_charges": [{"minimum": 270.68, "maximum": 300.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 270.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 300.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 300.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 300.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 300.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Miglustat oral 65 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1202", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.39, "maximum": 38.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 38.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Mild osa", "code_information": [{"code": "G8848", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Miscellaneous Dialysis Home Dialysis Aid Visit", "code_information": [{"code": "882", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Mobility current status", "code_information": [{"code": "G8978", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Mobility d/c status", "code_information": [{"code": "G8980", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Mobility goal status", "code_information": [{"code": "G8979", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Mometasone sinus implant", "code_information": [{"code": "S1090", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Motor speech current status", "code_information": [{"code": "G8999", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Motor speech d/c status", "code_information": [{"code": "G9158", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Motor speech goal status", "code_information": [{"code": "G9186", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Mri w/o cont, breast, bi", "code_information": [{"code": "C8907", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Mri w/o cont, breast, uni", "code_information": [{"code": "C8904", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Mst rcnt hbb < 10g/dl", "code_information": [{"code": "G8973", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Mycobacterium tuberculosis, culture filtrate protein-10-kDa (CFP-10), serum or plasma, liquid chromatography mass spectrometry (LC-MS)", "code_information": [{"code": "574U", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ CELIAC PELUS", "code_information": [{"code": "64530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ COMMON DIGIT", "code_information": [{"code": "64632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ HYPOGAS PLXS", "code_information": [{"code": "64517", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK LUMBAR/THORACIC", "code_information": [{"code": "64520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK SPENOPALATINE GANGL", "code_information": [{"code": "64505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK STELLATE GANGLION", "code_information": [{"code": "64510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N-ACETYL-PROCAINAMIDE", "code_information": [{"code": "80192", "type": "CPT"}, {"code": "4104143", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.45, "gross_charge": 824.0, "discounted_cash": 618.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 85.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N-ACETYL-PROCAINAMIDE", "code_information": [{"code": "80192", "type": "CPT"}, {"code": "7254143", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.45, "gross_charge": 240.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 85.45, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N-INVAS EST C FFR SW ALY CTA", "code_information": [{"code": "75580", "type": "CPT"}], "standard_charges": [{"minimum": 996.18, "maximum": 1614.79, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1453.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1614.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1614.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1614.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1614.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 996.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 996.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N. GONORRHOEAE ASSAY W/OPTIC", "code_information": [{"code": "87850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA DIR PROB", "code_information": [{"code": "87590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 102.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 102.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA QUANT", "code_information": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL ENDOSCOP PO DEBRID", "code_information": [{"code": "S2342", "type": "HCPCS"}], "standard_charges": [{"minimum": 3913.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL ENDOSCOPY DX", "code_information": [{"code": "31231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9027.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL FUNCTION STUDIES", "code_information": [{"code": "92512", "type": "CPT"}], "standard_charges": [{"minimum": 54.1, "maximum": 54.1, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 54.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 54.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 54.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 54.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 54.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL SINUS THERAPY", "code_information": [{"code": "30210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 84.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 84.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 84.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 84.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 84.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL SMEAR EOSINOPHILES", "code_information": [{"code": "89190", "type": "CPT"}, {"code": "4109190", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.24, "gross_charge": 124.0, "discounted_cash": 93.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/OROGASTRIC W/TUBE PLMT", "code_information": [{"code": "43752", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5290.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1159.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1159.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1159.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1159.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1159.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1221.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1221.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1221.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1221.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1221.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASOPHARYNGOSCOPY", "code_information": [{"code": "92511", "type": "CPT"}], "standard_charges": [{"minimum": 140.15, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 140.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 229.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 223.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 255.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 255.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 255.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 140.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 140.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 140.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 140.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAT KILLER CELL TOT CNT", "code_information": [{"code": "86357", "type": "CPT"}, {"code": "7250018", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 192.36, "gross_charge": 180.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 192.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NATALIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2323", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.6, "maximum": 24.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAVIGATIONAL BRONCHOSCOPY", "code_information": [{"code": "31627", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NCNTC IFR SPCTRSC O/T PAD EA", "code_information": [{"code": "859T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC IFR SPCTRSC SCR PAD", "code_information": [{"code": "860T", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC R-T FLUOR WND IMG 1ST", "code_information": [{"code": "598T", "type": "CPT"}], "standard_charges": [{"minimum": 264.45, "maximum": 264.45, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 264.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 264.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC R-T FLUOR WND IMG EA", "code_information": [{"code": "599T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDL CENTESIS YUEH", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8178171", "type": "CDM"}], "standard_charges": [{"minimum": 36.12, "maximum": 36.12, "gross_charge": 172.0, "discounted_cash": 129.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 36.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 1 OR 2 MUSC", "code_information": [{"code": "20560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 3+ MUSC", "code_information": [{"code": "20561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDL OCULOELECTROMYOGRAPHY 1+", "code_information": [{"code": "92265", "type": "CPT"}], "standard_charges": [{"minimum": 76.13, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 86.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 86.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 86.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 86.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 86.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDOVAG CRYG RF REMDL TISS", "code_information": [{"code": "672T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDSC DCMPRN 1 NTRSPC LUMBAR", "code_information": [{"code": "62380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDSC HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "33509", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEAR IFR 2IMG MIBMN GLND I&R", "code_information": [{"code": "507T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NECK FOR SOFT TISSUES", "code_information": [{"code": "70360", "type": "CPT"}, {"code": "4900360", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 255.78, "gross_charge": 1218.0, "discounted_cash": 913.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 255.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 57.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NECK FOR SOFT TISSUES", "code_information": [{"code": "70360", "type": "CPT"}, {"code": "5010360", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 255.78, "gross_charge": 1218.0, "discounted_cash": 913.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 255.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 57.69, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NECK SPINE DISK SURGERY", "code_information": [{"code": "63020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1109.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1109.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1109.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1109.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1109.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NECK SPINE DISK SURGERY", "code_information": [{"code": "63075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3880.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3880.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3880.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3880.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3880.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NECK SPINE DISK SURGERY", "code_information": [{"code": "63076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 249.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 249.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 249.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 249.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 249.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY CHEST LINING", "code_information": [{"code": "32400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LIVER ADD-ON", "code_information": [{"code": "47001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LYMPH NODES", "code_information": [{"code": "38505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8680.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 317.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY OF LIVER", "code_information": [{"code": "47000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3496.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY PANCREAS", "code_information": [{"code": "48102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY SPINAL CORD", "code_information": [{"code": "62269", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEG PRESS THRPY <=50CM", "code_information": [{"code": "97605", "type": "CPT"}, {"code": "6907608", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 28.7, "maximum": 274.82, "gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 247.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 240.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRESS THRPY >50CM", "code_information": [{"code": "97606", "type": "CPT"}, {"code": "6907609", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 30.65, "maximum": 489.19, "gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 440.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 427.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 489.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 489.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 489.19, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRESS TX MPD <50CM", "code_information": [{"code": "97607", "type": "CPT"}, {"code": "6900456", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 427.77, "maximum": 489.19, "gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 440.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 427.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 489.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 489.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 489.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRESS TX MPD >50CM", "code_information": [{"code": "97608", "type": "CPT"}, {"code": "6900457", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 427.77, "maximum": 489.19, "gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 440.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 427.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 489.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 489.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 489.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRESS VENTILATION CNP", "code_information": [{"code": "94662", "type": "CPT"}], "standard_charges": [{"minimum": 36.51, "maximum": 36.51, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.51, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEISSERIA MENINGITIDIS", "code_information": [{"code": "86741", "type": "CPT"}, {"code": "7256741", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "gross_charge": 131.0, "discounted_cash": 98.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NELARABINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9261", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.87, "maximum": 79.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 79.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 79.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 79.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 79.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOFORM VARIOUS SZ", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4024279", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 30.45, "maximum": 30.45, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 30.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOFORM VARIOUS SZ", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4024279", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 30.45, "maximum": 30.45, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 30.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOMYCIN 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308105", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEOMYCIN 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308105", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEONATE CRIT CARE INITIAL", "code_information": [{"code": "99468", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEONATE CRIT CARE SUBSQ", "code_information": [{"code": "99469", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [{"code": "794", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30.0, "maximum": 59398.73, "estimated_discounted_cash": 8616.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29869.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20529.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53458.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15971.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 56250.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31429.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16805.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21601.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17746.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33188.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 22810.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59398.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33188.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59398.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17746.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 22810.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59398.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33188.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17746.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 22810.34, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9576.91, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10668.84, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 19661.3, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 46663.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2377.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2996.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY", "code_information": [{"code": "789", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30.0, "maximum": 2996.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2377.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2996.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NEOX NEOX RT OR CLARIX CORD", "code_information": [{"code": "Q4148", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEPH CKD ALG RSK DBTC KDN DS", "code_information": [{"code": "385U", "type": "CPT"}], "standard_charges": [{"minimum": 390.75, "maximum": 390.75, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD MULT ECLIA TUM NEC", "code_information": [{"code": "105U", "type": "CPT"}], "standard_charges": [{"minimum": 950.0, "maximum": 950.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 950.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 950.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD NUC MRS MEAS GFR", "code_information": [{"code": "259U", "type": "CPT"}], "standard_charges": [{"minimum": 52.71, "maximum": 52.71, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 52.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 52.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD RSK HI STG KDN DS", "code_information": [{"code": "384U", "type": "CPT"}], "standard_charges": [{"minimum": 750.0, "maximum": 750.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH RNA PRETRNSPL PERPH BLD", "code_information": [{"code": "319U", "type": "CPT"}], "standard_charges": [{"minimum": 2650.0, "maximum": 2650.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2650.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2650.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH RNA PSTTRNSPL PERPH BLD", "code_information": [{"code": "320U", "type": "CPT"}], "standard_charges": [{"minimum": 2650.0, "maximum": 2650.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2650.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2650.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPHELOMETRY EA ANALYTE", "code_information": [{"code": "83883", "type": "CPT"}, {"code": "7253949", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.35, "gross_charge": 317.0, "discounted_cash": 237.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPHROTOMY W/EXPLORATION", "code_information": [{"code": "50045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 945.56, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 945.56, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 945.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 945.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 945.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERV COND STUDIES 3-4", "code_information": [{"code": "95908", "type": "CPT"}, {"code": "4705908", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 343.64, "maximum": 392.98, "gross_charge": 2011.0, "discounted_cash": 1508.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE COND STUDIES 1-2", "code_information": [{"code": "95907", "type": "CPT"}, {"code": "4705907", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "gross_charge": 742.0, "discounted_cash": 556.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE COND STUDIES 11-12", "code_information": [{"code": "95912", "type": "CPT"}, {"code": "4705912", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 620.07, "maximum": 709.1, "gross_charge": 930.0, "discounted_cash": 697.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE COND STUDIES 5-6", "code_information": [{"code": "95909", "type": "CPT"}, {"code": "4705909", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 343.64, "maximum": 392.98, "gross_charge": 2011.0, "discounted_cash": 1508.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE COND STUDIES 7-8", "code_information": [{"code": "95910", "type": "CPT"}, {"code": "4705910", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 343.64, "maximum": 392.98, "gross_charge": 1277.0, "discounted_cash": 957.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE COND STUDIES 9-10", "code_information": [{"code": "95911", "type": "CPT"}, {"code": "4705911", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 620.07, "maximum": 709.1, "gross_charge": 1621.0, "discounted_cash": 1215.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE COND STUDIES >13", "code_information": [{"code": "95913", "type": "CPT"}, {"code": "4705913", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 620.07, "maximum": 709.1, "gross_charge": 1318.0, "discounted_cash": 988.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT ADD-ON", "code_information": [{"code": "64901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT ADD-ON", "code_information": [{"code": "64902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT HEAD/NECK <4 CM", "code_information": [{"code": "64885", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT HEAD/NECK >4 CM", "code_information": [{"code": "64886", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY FASCIAL GRAFT", "code_information": [{"code": "15840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MICROSURG GRAFT", "code_information": [{"code": "15842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MUSCLE GRAFT", "code_information": [{"code": "15841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64907", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE REPAIR W/ALLOGRAFT", "code_information": [{"code": "64910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE SURGERY", "code_information": [{"code": "64859", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE TEASING PREPARATIONS", "code_information": [{"code": "88362", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 656.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 560.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 301.82, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 301.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 301.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 301.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 301.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVOUS SYSTEM NEOPLASMS WITH MCC", "code_information": [{"code": "54", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5014.8, "maximum": 63883.97, "estimated_discounted_cash": 46951.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15479.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10214.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24173.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12436.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16288.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25436.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10748.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13086.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13818.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11349.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 26859.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17199.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17199.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 26859.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11349.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13818.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11349.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 26859.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13818.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17199.6, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5014.8, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6896.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 22721.84, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9903.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50696.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63883.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVOUS SYSTEM NEOPLASMS WITHOUT MCC", "code_information": [{"code": "55", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6186.31, "maximum": 48623.62, "estimated_discounted_cash": 50366.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24767.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11733.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16527.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 43760.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17390.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12345.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 46046.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26061.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13036.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 48623.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27519.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18363.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27519.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18363.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13036.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 48623.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 48623.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27519.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18363.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13036.92, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 32712.29, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6186.31, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 15155.28, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9068.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33852.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42659.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NESIRITIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2325", "type": "HCPCS"}], "standard_charges": [{"minimum": 54.23, "maximum": 60.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 54.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 60.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 60.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 60.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 60.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEU PRKSN MSFL A-SYNCLN PRTN", "code_information": [{"code": "393U", "type": "CPT"}], "standard_charges": [{"minimum": 540.99, "maximum": 540.99, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 540.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 540.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEU PRKSN MSFL _-SYNCLN PRTN", "code_information": [{"code": "394U", "type": "CPT"}], "standard_charges": [{"minimum": 198.74, "maximum": 198.74, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 198.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 198.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURAGEN PER CM", "code_information": [{"code": "C9352", "type": "HCPCS"}, {"code": "4024252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3682.98, "maximum": 3682.98, "gross_charge": 17538.0, "discounted_cash": 13153.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3682.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURAWRAP PER CM", "code_information": [{"code": "C9353", "type": "HCPCS"}, {"code": "4024253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2275.77, "maximum": 2275.77, "gross_charge": 10837.0, "discounted_cash": 8127.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2275.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY FOOT", "code_information": [{"code": "28055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY HAMSTRING", "code_information": [{"code": "27325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY POPLITEAL", "code_information": [{"code": "27326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURFLMNT LT CHN DIG IA QUAN", "code_information": [{"code": "361U", "type": "CPT"}], "standard_charges": [{"minimum": 116.23, "maximum": 116.23, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 116.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 116.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALYS B-AMYL 1-42&1-40", "code_information": [{"code": "358U", "type": "CPT"}], "standard_charges": [{"minimum": 260.5, "maximum": 260.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 260.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 260.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER CELL AGGREGJ", "code_information": [{"code": "206U", "type": "CPT"}], "standard_charges": [{"minimum": 2215.4, "maximum": 2215.4, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2215.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2215.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER MRNA 24 GEN", "code_information": [{"code": "289U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER QUAN IMAGING", "code_information": [{"code": "207U", "type": "CPT"}], "standard_charges": [{"minimum": 511.2, "maximum": 511.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 511.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 511.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 14 ACYL CARN", "code_information": [{"code": "322U", "type": "CPT"}], "standard_charges": [{"minimum": 750.0, "maximum": 750.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 16 C METBLT", "code_information": [{"code": "263U", "type": "CPT"}], "standard_charges": [{"minimum": 750.0, "maximum": 750.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD RNA NEXT GEN SEQ", "code_information": [{"code": "170U", "type": "CPT"}], "standard_charges": [{"minimum": 1755.0, "maximum": 1755.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1755.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1755.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO AUTISM 32 AMINES ALG", "code_information": [{"code": "63U", "type": "CPT"}], "standard_charges": [{"minimum": 750.0, "maximum": 750.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO CERE FOLATE DEFNCY SRM", "code_information": [{"code": "410U", "type": "CPT"}], "standard_charges": [{"minimum": 1160.0, "maximum": 1160.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1160.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO CERE FOLATE DEFNCY SRM", "code_information": [{"code": "412U", "type": "CPT"}], "standard_charges": [{"minimum": 750.0, "maximum": 750.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO CSF PRION PRTN QUAL", "code_information": [{"code": "35U", "type": "CPT"}], "standard_charges": [{"minimum": 540.99, "maximum": 540.99, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 540.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 540.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 12 COM", "code_information": [{"code": "216U", "type": "CPT"}], "standard_charges": [{"minimum": 1537.02, "maximum": 1537.02, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1537.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1537.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 51 GENE", "code_information": [{"code": "217U", "type": "CPT"}], "standard_charges": [{"minimum": 2198.35, "maximum": 2198.35, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2198.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2198.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO MUSC DYS DMD SEQ ALYS", "code_information": [{"code": "218U", "type": "CPT"}], "standard_charges": [{"minimum": 2279.0, "maximum": 2279.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2279.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2279.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROELTRD STIM POST TIBIAL", "code_information": [{"code": "64566", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROENDOSCOPY ADD-ON", "code_information": [{"code": "62160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 186.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 186.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 186.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 186.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 186.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROLOGICAL EYE DISORDERS", "code_information": [{"code": "123", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26515.12, "maximum": 33412.63, "estimated_discounted_cash": 56568.4, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26515.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33412.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROMATRIX NERVE CUFF, CM", "code_information": [{"code": "C9355", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEUROMEND WRAP PER 0.5CM", "code_information": [{"code": "C9361", "type": "HCPCS"}, {"code": "4024258", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1217.58, "maximum": 1217.58, "gross_charge": 5798.0, "discounted_cash": 4348.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1217.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROMEND WRAP PER 0.5CM", "code_information": [{"code": "C9361", "type": "HCPCS"}, {"code": "4024258", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1217.58, "maximum": 1217.58, "gross_charge": 5798.0, "discounted_cash": 4348.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1217.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROMUSCULAR JNCTN TEST", "code_information": [{"code": "95937", "type": "CPT"}, {"code": "4705937", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 60.17, "maximum": 211.75, "gross_charge": 812.0, "discounted_cash": 609.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROMUSCULAR REEDUCATION", "code_information": [{"code": "97112", "type": "CPT"}], "standard_charges": [{"minimum": 24.32, "maximum": 80.98, "estimated_discounted_cash": 271.45, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 72.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 70.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 80.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 80.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 80.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROMYELITIS OPTICA", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "7253501", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.03, "gross_charge": 578.0, "discounted_cash": 433.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURORRAPHY W/VEIN AUTOGRAFT", "code_information": [{"code": "64911", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 787.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 787.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 787.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 787.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 787.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROSES EXCEPT DEPRESSIVE", "code_information": [{"code": "882", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1421.0, "maximum": 44926.72, "estimated_discounted_cash": 53947.93, "setting": "inpatient", "payers_information": [{"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "standard_charge_dollar": 1421.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35652.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44926.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROVASCULAR PEDICLE FLAP", "code_information": [{"code": "15750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURSTIM+EXT ITREL III", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "8242402", "type": "CDM"}], "standard_charges": [{"minimum": 11742.99, "maximum": 11742.99, "gross_charge": 55919.0, "discounted_cash": 41939.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 11742.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRALIZATN TEST VIRAL", "code_information": [{"code": "86382", "type": "CPT"}, {"code": "7256387", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 86.21, "gross_charge": 324.0, "discounted_cash": 243.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 86.21, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRLZG ANTB SARSCOV2 SCR", "code_information": [{"code": "86408", "type": "CPT"}], "standard_charges": [{"minimum": 42.22, "maximum": 42.22, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRLZG ANTB SARSCOV2 TITER", "code_information": [{"code": "86409", "type": "CPT"}], "standard_charges": [{"minimum": 105.38, "maximum": 105.38, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 105.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 105.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRON BEAM TX COMPLEX", "code_information": [{"code": "77423", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 900.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 227.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 810.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 900.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 227.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 227.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 227.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 227.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEVIRAPINE 10MG/ML 1MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315804", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEVIRAPINE 10MG/ML 1MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315804", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEVIRAPINE 10MG/ML 5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315842", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NEVIRAPINE 10MG/ML 5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315842", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NEW LENSES IN PTS OLD FRAME", "code_information": [{"code": "S0595", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEWBORN LEVEL I", "code_information": [{"code": "1990010", "type": "CDM"}, {"code": "171", "type": "RC"}], "standard_charges": [{"gross_charge": 2144.0, "discounted_cash": 1608.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEWBORN LEVEL I", "code_information": [{"code": "2550010", "type": "CDM"}, {"code": "171", "type": "RC"}], "standard_charges": [{"gross_charge": 2144.0, "discounted_cash": 1608.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEWBORN LEVEL II", "code_information": [{"code": "1990012", "type": "CDM"}, {"code": "172", "type": "RC"}], "standard_charges": [{"gross_charge": 11065.0, "discounted_cash": 8298.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEWBORN LEVEL II", "code_information": [{"code": "2210012", "type": "CDM"}, {"code": "172", "type": "RC"}], "standard_charges": [{"gross_charge": 11065.0, "discounted_cash": 8298.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEWBORN METABOLIC SCREENING", "code_information": [{"code": "S3620", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEWBORN OTHER", "code_information": [{"code": "1990011", "type": "CDM"}, {"code": "179", "type": "RC"}], "standard_charges": [{"gross_charge": 2144.0, "discounted_cash": 1608.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEWBORN OTHER", "code_information": [{"code": "2550011", "type": "CDM"}, {"code": "179", "type": "RC"}], "standard_charges": [{"gross_charge": 2144.0, "discounted_cash": 1608.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NF DSCHRG MGMT 30 MIN+", "code_information": [{"code": "99316", "type": "CPT"}], "standard_charges": [{"minimum": 78.33, "maximum": 78.33, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NF DSCHRG MGMT 30 MIN/LESS", "code_information": [{"code": "99315", "type": "CPT"}], "standard_charges": [{"minimum": 59.87, "maximum": 59.87, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 59.87, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 59.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 59.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 59.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 59.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGENT DETECTION GI", "code_information": [{"code": "87505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 586.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 586.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 128.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 128.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS CMV", "code_information": [{"code": "87910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1314.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1314.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 257.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 257.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS SARSCOV2", "code_information": [{"code": "87913", "type": "CPT"}], "standard_charges": [{"minimum": 257.45, "maximum": 257.45, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 257.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 257.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT HIV GNRJ SEQ ALYS", "code_information": [{"code": "219U", "type": "CPT"}], "standard_charges": [{"minimum": 725.0, "maximum": 725.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 725.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 725.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT STI MULT AMP PRB TQ", "code_information": [{"code": "402U", "type": "CPT"}], "standard_charges": [{"minimum": 142.63, "maximum": 142.63, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT STI MULT AMP PRB TQ", "code_information": [{"code": "736T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", "code_information": [{"code": "223U", "type": "CPT"}], "standard_charges": [{"minimum": 416.62, "maximum": 416.62, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 416.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM NEG", "code_information": [{"code": "142U", "type": "CPT"}], "standard_charges": [{"minimum": 156.75, "maximum": 156.75, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 156.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 156.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM POS", "code_information": [{"code": "141U", "type": "CPT"}], "standard_charges": [{"minimum": 156.75, "maximum": 156.75, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 156.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 156.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG ORG ID 6+", "code_information": [{"code": "86U", "type": "CPT"}], "standard_charges": [{"minimum": 200.0, "maximum": 200.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 200.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT QUAN ANTMCRB SC", "code_information": [{"code": "311U", "type": "CPT"}], "standard_charges": [{"minimum": 8.08, "maximum": 8.08, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT/VIRAL TRAIL IP10", "code_information": [{"code": "351U", "type": "CPT"}], "standard_charges": [{"minimum": 260.5, "maximum": 260.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 260.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 260.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV RNA VAG FLU ALG", "code_information": [{"code": "81513", "type": "CPT"}], "standard_charges": [{"minimum": 142.63, "maximum": 142.63, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS DNA ALG", "code_information": [{"code": "81514", "type": "CPT"}], "standard_charges": [{"minimum": 262.99, "maximum": 262.99, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS CHRNC HCV 6 ASSAYS", "code_information": [{"code": "81596", "type": "CPT"}, {"code": "7251596", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 72.19, "maximum": 72.19, "gross_charge": 412.0, "discounted_cash": 309.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 72.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 72.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA UNTRGT NGNRJ SEQ", "code_information": [{"code": "152U", "type": "CPT"}], "standard_charges": [{"minimum": 2126.2, "maximum": 2126.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2126.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2126.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA&RNA 21 SARSCOV2", "code_information": [{"code": "225U", "type": "CPT"}], "standard_charges": [{"minimum": 416.62, "maximum": 416.62, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 416.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS FUNGI DNA 15 TRGT", "code_information": [{"code": "140U", "type": "CPT"}], "standard_charges": [{"minimum": 156.75, "maximum": 156.75, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 156.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 156.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS GU PTHGN ARG DETCJ", "code_information": [{"code": "372U", "type": "CPT"}], "standard_charges": [{"minimum": 416.78, "maximum": 416.78, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS STRN TYP WHL GEN SEQ", "code_information": [{"code": "10U", "type": "CPT"}], "standard_charges": [{"minimum": 427.26, "maximum": 427.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 427.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 427.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFROS NFROT W/DRG", "code_information": [{"code": "50040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 953.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 953.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 953.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 953.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 953.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NICARDIPINE 20MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308271", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 18.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NICARDIPINE 20MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308271", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 18.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NICARDIPINE 30MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308272", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NICARDIPINE 30MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308272", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 26.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NICKEL", "code_information": [{"code": "83885", "type": "CPT"}, {"code": "7253947", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 124.94, "gross_charge": 557.0, "discounted_cash": 417.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 124.94, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 34.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 34.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 34.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 34.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 34.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NICOTINE PATCH LEGEND", "code_information": [{"code": "S4990", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NICOTINE PATCH NONLEGEND", "code_information": [{"code": "S4991", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NICU NB LVL III", "code_information": [{"code": "1990070", "type": "CDM"}, {"code": "173", "type": "RC"}], "standard_charges": [{"gross_charge": 11697.0, "discounted_cash": 8772.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NICU NB LVL III", "code_information": [{"code": "2210070", "type": "CDM"}, {"code": "173", "type": "RC"}], "standard_charges": [{"gross_charge": 11697.0, "discounted_cash": 8772.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NICU NB LVL IV", "code_information": [{"code": "1990020", "type": "CDM"}, {"code": "174", "type": "RC"}], "standard_charges": [{"gross_charge": 12963.0, "discounted_cash": 9722.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NICU NB LVL IV", "code_information": [{"code": "2210020", "type": "CDM"}, {"code": "174", "type": "RC"}], "standard_charges": [{"gross_charge": 12963.0, "discounted_cash": 9722.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NICU PNEUMOGRAM", "code_information": [{"code": "94772", "type": "CPT"}, {"code": "3110200", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 620.07, "maximum": 709.1, "gross_charge": 3968.0, "discounted_cash": 2976.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIFEDIPINE 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308312", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NIFEDIPINE 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308312", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NIFEDIPINE 30MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308310", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIFEDIPINE 30MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308310", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIFEDIPINE 60MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308309", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIFEDIPINE 60MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308309", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIFEDIPINE 90MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308308", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NIFEDIPINE 90MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308308", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NIKAIDOH PROC", "code_information": [{"code": "33782", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NIKAIDOH PROC W/OSTIA IMPLT", "code_information": [{"code": "33783", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NIMODIPINE 30MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308320", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIMODIPINE 30MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308320", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIPPLE EXPLORATION", "code_information": [{"code": "19110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NIRMATR-RITON 150/100 DOSE 2TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308348", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 722.0, "discounted_cash": 541.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NIRMATR-RITON 150/100 DOSE 2TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308348", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 722.0, "discounted_cash": 541.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NIRMATR-RITON 300/100 DOSE 3TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308349", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 701.0, "discounted_cash": 525.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIRMATR-RITON 300/100 DOSE 3TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308349", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 701.0, "discounted_cash": 525.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NITAZOXANID100MG/5MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315862", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 247.0, "discounted_cash": 185.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NITAZOXANID100MG/5MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315862", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 247.0, "discounted_cash": 185.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROBLUE TETRAZOLIUM DYE", "code_information": [{"code": "86384", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.07, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NITROFURANTOIN 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308337", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROFURANTOIN 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308337", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROFURANTOIN 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308335", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROFURANTOIN 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308335", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROGLYCERIN .3MG SL TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308374", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROGLYCERIN .3MG SL TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308374", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROGLYCERIN .4MG SL TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308378", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROGLYCERIN .4MG SL TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308378", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROGLYCERIN .6MG SL TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308382", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROGLYCERIN .6MG SL TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308382", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROGLYCERIN.4MGSL 25TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308379", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 18.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROGLYCERIN.4MGSL 25TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308379", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 18.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIVESTYM", "code_information": [{"code": "Q5110", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.27, "maximum": 0.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIVOLUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9299", "type": "HCPCS"}, {"code": "5322881", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 29.66, "maximum": 32.96, "gross_charge": 143.0, "discounted_cash": 107.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIVOLUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9299", "type": "HCPCS"}, {"code": "5322881", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 29.66, "maximum": 32.96, "gross_charge": 143.0, "discounted_cash": 107.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD AX NERVE IMG", "code_information": [{"code": "64417", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD BRCH PL NFS IMG", "code_information": [{"code": "64416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD BRCH PLXS IMG", "code_information": [{"code": "64415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 24863.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD FEM NRV NFS IMG", "code_information": [{"code": "64448", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 147.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 147.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 147.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 147.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 147.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD FEMORAL NRV IMG", "code_information": [{"code": "64447", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15576.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD GNCLR NRV BRNCH", "code_information": [{"code": "64454", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD GR OCPL NRV", "code_information": [{"code": "64405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2436.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD II IH NERVES", "code_information": [{"code": "64425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 54.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 54.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 54.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 54.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 54.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD LMBR PLEX NFS", "code_information": [{"code": "64449", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 146.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 146.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 146.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 146.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 146.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NRV NRVTG SI JT", "code_information": [{"code": "64451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NTRCOST NRV 1", "code_information": [{"code": "64420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NTRCOST NRV EA", "code_information": [{"code": "64421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD OTHER PN/BRANCH", "code_information": [{"code": "64450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5975.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PARACRV NRV", "code_information": [{"code": "64435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PLTR COM DG NRV", "code_information": [{"code": "64455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PUDENDAL NERVE", "code_information": [{"code": "64430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SC NRV NFS IMG", "code_information": [{"code": "64446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SCIATIC NRV IMG", "code_information": [{"code": "64445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 19990.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SPRSCAP NRV", "code_information": [{"code": "64418", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TFRM EPI C/T 1", "code_information": [{"code": "64479", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TFRM EPI C/T EA", "code_information": [{"code": "64480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TFRM EPI L/S 1", "code_information": [{"code": "64483", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TFRM EPI L/S EA", "code_information": [{"code": "64484", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TRIGEMINAL NRV", "code_information": [{"code": "64400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2436.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD VAGUS NRV", "code_information": [{"code": "64408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 55.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 55.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 55.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 55.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 55.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AUTOL WBC CONCENTRATE", "code_information": [{"code": "481T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX B1 SUB MTRL SBCHDRL DFCT", "code_information": [{"code": "707T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT P ANGRPH MAPCA", "code_information": [{"code": "93575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT P-ART ANGRP BI", "code_information": [{"code": "93573", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT PULM VN ANGRPH", "code_information": [{"code": "93574", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CATH SLCTV OPAC", "code_information": [{"code": "93564", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CTH SLCTV C ANG", "code_information": [{"code": "93563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CHEMONUCLEOLYSIS LMBR", "code_information": [{"code": "62292", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CNTRST KNE ARTHG/CT/MRI", "code_information": [{"code": "27369", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CTH SLCT P-ART ANGRP UNI", "code_information": [{"code": "93569", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14728.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62324", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15631.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT 1 VEIN", "code_information": [{"code": "36465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT MLT VN", "code_information": [{"code": "36466", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "213T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "214T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "215T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "216T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "217T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "218T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PST CHMBR EYE MEDICATION", "code_information": [{"code": "699T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX DISCOGRAPHY CRV/THRC", "code_information": [{"code": "62291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 341.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 341.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 341.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 341.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 341.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX DISCOGRAPHY LUMBAR", "code_information": [{"code": "62290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 377.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 377.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 377.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 377.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 377.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRM &/URTRGRM", "code_information": [{"code": "50430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRM &/URTRGRM", "code_information": [{"code": "50431", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX ONLY MAM DUCTO/GLCTO", "code_information": [{"code": "19030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 182.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 182.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 182.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 182.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 182.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT 1 INCMPTNT VEIN", "code_information": [{"code": "36470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT MLT INCMPTNT VN", "code_information": [{"code": "36471", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT SPIDER VEINS", "code_information": [{"code": "36468", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX STM CL PRDCT ANL SFT TIS", "code_information": [{"code": "748T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NL COMP CGEN KDN ABNORMALITY", "code_information": [{"code": "50070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1233.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1233.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1233.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1233.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1233.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NL REMOVAL CALCULUS", "code_information": [{"code": "50060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1180.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1180.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1180.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1180.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1180.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NL RMVL LG STAGHORN CALCULUS", "code_information": [{"code": "50075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1511.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1511.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1511.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1511.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1511.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NL SEC SURG OPERJ CALCULUS", "code_information": [{"code": "50065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1209.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1209.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1209.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1209.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1209.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NO AHI OR RDI INITIAL DX", "code_information": [{"code": "G8844", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ANTIBIO W IN 10D OF SYMPT", "code_information": [{"code": "G9287", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ASA/ANTIPLAT THER USE RNG", "code_information": [{"code": "G8599", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ASSESS BONE LOSS", "code_information": [{"code": "G8863", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO BP MEASURE DOC", "code_information": [{"code": "G8756", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO BRST CNCR DX MIN INVASIVE", "code_information": [{"code": "G8877", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC COMM RISK CALC", "code_information": [{"code": "G9317", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC COUNT OF CT IN 12MO", "code_information": [{"code": "G9322", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC CUR FUNCT ASSESS", "code_information": [{"code": "G8541", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC ELDER MAL SCRN", "code_information": [{"code": "G8536", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC OF DSM-IV", "code_information": [{"code": "G9213", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC SHARE DEC PRIOR PROC", "code_information": [{"code": "G9297", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO DOC TYPE NSM LUNG CA", "code_information": [{"code": "G9290", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO EARLY IND/DELIVERY", "code_information": [{"code": "G9355", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ELIG REF FOR OTO EVAL", "code_information": [{"code": "G8857", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO ELIG TPA INIT W/IN 4.5 HR", "code_information": [{"code": "G8601", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO EVAL RISK VTE CARD PRIOR", "code_information": [{"code": "G9299", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO FOLLOW UP PULM NOD NORSN", "code_information": [{"code": "G9347", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO HIST TYPE DOC ON REPORT", "code_information": [{"code": "G9284", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO IMPROVE VISUAL FUNCT", "code_information": [{"code": "G0915", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO INTERV REQ FOR LEAK", "code_information": [{"code": "G9305", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO MED VISIT IN 24MO", "code_information": [{"code": "G9246", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO MRS 90 DAYS POST STK", "code_information": [{"code": "G0046", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PAP PRESCRIBED", "code_information": [{"code": "G8850", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PHARM THER OSTEO RX", "code_information": [{"code": "G8635", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PNEUMOCOCCAL ADMIN", "code_information": [{"code": "G8867", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO POSTOP REN FAIL", "code_information": [{"code": "G8576", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PROL INTUB REQ", "code_information": [{"code": "G8570", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO PT CATEGORY ON REPORT", "code_information": [{"code": "G9293", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO REOP REQ BLD GRFT OTH", "code_information": [{"code": "G8578", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO RET FOR SURG W IN 30D", "code_information": [{"code": "G9307", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO RSK FAC OR 1 MOD RISK TE", "code_information": [{"code": "G8970", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO RX ACE/ARB THERAPY", "code_information": [{"code": "G8937", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SATISFY WITH CARE", "code_information": [{"code": "G0918", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SENT LYMPH NODE BIOPSY", "code_information": [{"code": "G8882", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SIGNS MELANOMA", "code_information": [{"code": "G8749", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SLEEP APNEA ASSESS", "code_information": [{"code": "G8841", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SRCH FOR CT IN 12MO NORSN", "code_information": [{"code": "G9342", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO SURG SITE INFECTION", "code_information": [{"code": "G9311", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO TA TV ULTRASND", "code_information": [{"code": "G8807", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO TPA INIT W/IN 4.5 HR", "code_information": [{"code": "G8602", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NO UNPLND HOSP READM IN 30D", "code_information": [{"code": "G9309", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOCARDIA ANTIBODY", "code_information": [{"code": "86744", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON CUTANEOUS LOC", "code_information": [{"code": "G9295", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC", "code_information": [{"code": "98", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10333.56, "maximum": 96016.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15633.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36400.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21645.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 62100.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 38301.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16449.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 65344.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22776.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 40445.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 69001.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24051.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17370.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40445.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 69001.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24051.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17370.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40445.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 69001.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24051.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER 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CROSS OUT OF STATE", "standard_charge_dollar": 24209.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 55607.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10862.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15740.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24209.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15740.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10862.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 55607.69, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7690.49, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9389.05, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 20414.04, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 47538.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 119918.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 151114.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC", "code_information": [{"code": "99", "type": "MS-DRG"}], "standard_charges": [{"minimum": 45234.4, "maximum": 57001.45, "estimated_discounted_cash": 107915.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 45234.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 57001.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-BLIND INTERATRIAL SHUNT", "code_information": [{"code": "C9760", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 11202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-COV PROC, CLINICAL TRIAL", "code_information": [{"code": "G0294", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-COV SURG PROC,CLIN TRIAL", "code_information": [{"code": "G0293", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-EMER TRANSPORT WAIT TIME", "code_information": [{"code": "T2007", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE BURNS", "code_information": [{"code": "935", "type": "MS-DRG"}], "standard_charges": [{"minimum": 68396.12, "maximum": 86188.34, "estimated_discounted_cash": 40027.43, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 68396.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 86188.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "988", "type": "MS-DRG"}], "standard_charges": [{"minimum": 54570.81, "maximum": 68766.58, "estimated_discounted_cash": 48890.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 54570.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 68766.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [{"code": "987", "type": "MS-DRG"}], "standard_charges": [{"minimum": 113829.74, "maximum": 143440.83, "estimated_discounted_cash": 89363.7, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 113829.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 143440.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "989", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39815.84, "maximum": 50173.33, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39815.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 50173.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-HEU TC-99M ADD-ON/DOSE", "code_information": [{"code": "Q9969", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.37, "maximum": 9.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-IMAGING HEART FUNCTION", "code_information": [{"code": "78414", "type": "CPT"}], "standard_charges": [{"minimum": 489.4, "maximum": 489.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-INVAS VASC DX STDY", "code_information": [{"code": "93998", "type": "CPT"}, {"code": "6903998", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"gross_charge": 179.0, "discounted_cash": 134.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NON-MALIGNANT BREAST DISORDERS WITH CC/MCC", "code_information": [{"code": "600", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34583.2, "maximum": 43579.5, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 34583.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 43579.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "601", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20087.21, "maximum": 25312.59, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20087.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25312.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-OPHTHALMIC FVA", "code_information": [{"code": "C9733", "type": "HCPCS"}], "standard_charges": [{"minimum": 368.12, "maximum": 368.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-PRSCRP LENS", "code_information": [{"code": "S0510", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOS IMMUNOASSAY NON-RIA/4", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "7258382", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.03, "gross_charge": 294.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK 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[{"code": "83520", "type": "CPT"}, {"code": "7250235", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.03, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOSE ALLERGY TEST", "code_information": [{"code": "95065", "type": "CPT"}], "standard_charges": [{"minimum": 21.01, "maximum": 21.01, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOT >1 SINUS CT W 90D DX", "code_information": [{"code": "G9352", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT DISCH HOME BY DAY #2", "code_information": [{"code": "G8838", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT MEDICALLY NECESSARY SVC", "code_information": [{"code": "S9986", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT NSM LUNG CA", "code_information": [{"code": "G9291", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT PRES ANTIBIOTIC", "code_information": [{"code": "G8712", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NOT REF FOR OTO EVAL", "code_information": [{"code": "G8858", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NPM1 EXON 12 VARIANTS", "code_information": [{"code": "81310", "type": "CPT"}, {"code": "4100097", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 925.17, "gross_charge": 3859.0, "discounted_cash": 2894.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 925.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 246.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 246.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NPM1 GENE ANALYSIS QUAN", "code_information": [{"code": "49U", "type": "CPT"}], "standard_charges": [{"minimum": 407.43, "maximum": 407.43, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 407.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 407.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NPS SURG DILAT EUST TUBE BI", "code_information": [{"code": "69706", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 8432.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NPS SURG DILAT EUST TUBE UNI", "code_information": [{"code": "69705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 7143.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRAS GENE VARIANTS EXON 2&3", "code_information": [{"code": "81311", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1108.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1108.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 295.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 295.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRPSYC GEN SEQ VRNT ALY 13", "code_information": [{"code": "419U", "type": "CPT"}], "standard_charges": [{"minimum": 1336.09, "maximum": 1336.09, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1336.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1336.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRPSYC TST EVAL PHYS/QHP 1ST", "code_information": [{"code": "96132", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND ARM/LEG <4CM", "code_information": [{"code": "64892", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND ARM/LEG >4 CM", "code_information": [{"code": "64893", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND HND/FOOT <4CM", "code_information": [{"code": "64890", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND HND/FOOT >4CM", "code_information": [{"code": "64891", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST ARM/LEG <4 CM", "code_information": [{"code": "64897", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST ARM/LEG >4 CM", "code_information": [{"code": "64898", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST HND/FOOT <4 CM", "code_information": [{"code": "64895", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST HND/FOOT >4 CM", "code_information": [{"code": "64896", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV RPR W/NRV ALGRFT 1ST", "code_information": [{"code": "64912", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV RPR W/NRV ALGRFT EA ADDL", "code_information": [{"code": "64913", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSEL DEB WNDS WO ANES B", "code_information": [{"code": "97602", "type": "CPT"}, {"code": "6907605", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 240.32, "maximum": 274.82, "gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 247.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 240.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSEL DEB WNDS WO ANES B", "code_information": [{"code": "97602", "type": "CPT"}, {"code": "6907605", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 240.32, "maximum": 274.82, "gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 247.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 240.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC DX MAX SINUSC", "code_information": [{"code": "31233", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC DX SPHN SINUSC", "code_information": [{"code": "31235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC FRNT TISS RMVL", "code_information": [{"code": "31276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5498.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED&INF DCMPRN", "code_information": [{"code": "31293", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1093.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1093.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1093.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1093.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1093.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED/INF DCMPRN", "code_information": [{"code": "31292", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1005.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1005.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1005.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1005.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1005.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SPHN TISS RMVL", "code_information": [{"code": "31259", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 5741.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SRG NSL HEMRRG", "code_information": [{"code": "31238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG BX POLYPC", "code_information": [{"code": "31237", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6957.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG FRNT SINS", "code_information": [{"code": "31296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG FRNT&SPHN", "code_information": [{"code": "31298", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG MAX SINS", "code_information": [{"code": "31295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG ON DCMPRN", "code_information": [{"code": "31294", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1254.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1254.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1254.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1254.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1254.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG SPHN SINS", "code_information": [{"code": "31297", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC TOT W/SPHENDT", "code_information": [{"code": "31257", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 5768.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC TOTAL", "code_information": [{"code": "31253", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC W/PRTL ETHMDCT", "code_information": [{"code": "31254", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3429.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC W/TOT ETHMDCT", "code_information": [{"code": "31255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 6988.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS ENDOSCOPY SURG DCR", "code_information": [{"code": "31239", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS NDSC CRYOABLTJ PNN", "code_information": [{"code": "31243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS NDSC RF ABLTJ PNN", "code_information": [{"code": "31242", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SNS NDSC CNCH BULL RESCJ", "code_information": [{"code": "31240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4880.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SNS NDSC LIG SPHNPTN ART", "code_information": [{"code": "31241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSTIM GASTRIC ENTERRA II", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "4008503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11976.09, "maximum": 11976.09, "gross_charge": 57029.0, "discounted_cash": 42771.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 11976.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTIOL CATEGORY 4", "code_information": [{"code": "Q1004", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTIOL CATEGORY 5", "code_information": [{"code": "Q1005", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRAOP HIPEC PX EA ADD 30MIN", "code_information": [{"code": "96548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NTRAPX C FFR W/3D FUNCJL MAP", "code_information": [{"code": "523T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NTRK TRANSLOCATION ANALYSIS", "code_information": [{"code": "81194", "type": "CPT"}, {"code": "7270168", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 518.28, "maximum": 518.28, "gross_charge": 3527.0, "discounted_cash": 2645.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 518.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 518.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK1 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81191", "type": "CPT"}], "standard_charges": [{"minimum": 207.31, "maximum": 207.31, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK2 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81192", "type": "CPT"}], "standard_charges": [{"minimum": 207.31, "maximum": 207.31, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 207.31, "methodology": "fee 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PROVIDER NETWORK WC", "standard_charge_dollar": 78.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 78.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 78.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 78.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 78.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR ANTIGEN AB", "code_information": [{"code": "86235", "type": "CPT"}, {"code": "7256214", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 91.47, "gross_charge": 440.0, "discounted_cash": 330.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 91.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR ANTIGEN AB/11", "code_information": [{"code": "86235", "type": "CPT"}, {"code": "7256239", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 91.47, "gross_charge": 104.0, "discounted_cash": 78.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 91.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR ANTIGEN AB/15", "code_information": [{"code": "86235", "type": "CPT"}, {"code": "7256271", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 91.47, "gross_charge": 104.0, "discounted_cash": 78.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 91.47, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR ANTIGEN AB/23", "code_information": [{"code": "86235", "type": "CPT"}, {"code": "7258623", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 91.47, "gross_charge": 234.0, "discounted_cash": 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NETWORK WC", "standard_charge_dollar": 132.84, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 132.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 132.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 132.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 132.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 75 Minutes", "code_information": [{"code": "99328", "type": "CPT"}], "standard_charges": [{"minimum": 203.82, "maximum": 203.82, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 203.82, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 203.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 203.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 203.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 203.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Home Visit, Typically 45 Minutes", "code_information": [{"code": "99343", "type": "CPT"}], "standard_charges": [{"minimum": 129.88, "maximum": 129.88, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 129.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 129.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 129.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 129.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 129.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Office Or Other Outpatient Visit, Typically 10 Minutes", "code_information": [{"code": "99201", "type": "CPT"}], "standard_charges": [{"minimum": 40.2, "maximum": 40.2, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.2, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "No 1st antitnf", "code_information": [{"code": "G8871", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No antlipid treat disch", "code_information": [{"code": "G8587", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No antplt med disch", "code_information": [{"code": "G8581", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No auto av fistula; no reas", "code_information": [{"code": "G8532", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No bblock disch", "code_information": [{"code": "G8584", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No cd4 count no reason", "code_information": [{"code": "G9215", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No corticostrd 10mg 60 days", "code_information": [{"code": "G8862", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No counsel diet phys act", "code_information": [{"code": "G8782", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No diabetes screen", "code_information": [{"code": "G8779", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No doc bp", "code_information": [{"code": "G8889", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No doc of neg or man pos tb", "code_information": [{"code": "G9360", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No doc of pain", "code_information": [{"code": "G8732", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No doc sinus ct 28d or dx", "code_information": [{"code": "G9350", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No follow up pulm nod", "code_information": [{"code": "G9346", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No hepc rna after med docrsn", "code_information": [{"code": "G9210", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No hepc rna after med no rsn", "code_information": [{"code": "G9211", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No lipid prof perf", "code_information": [{"code": "G8594", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No med visit 6mo", "code_information": [{"code": "G9248", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No neo detect scrn colo", "code_information": [{"code": "G9253", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No neuropsych symptoms", "code_information": [{"code": "G8948", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No oder pjp for med reason", "code_information": [{"code": "G9219", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No order for ceph no reason", "code_information": [{"code": "G9198", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No order for pjp for medrsn", "code_information": [{"code": "G9220", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No pcp prop low at cd4 norsn", "code_information": [{"code": "G9218", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No pcp proph at dx no reason", "code_information": [{"code": "G9216", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No pcp proph low cd4 norsn", "code_information": [{"code": "G9217", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No reason for no hep c geno", "code_information": [{"code": "G9208", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No reason for no hep c rna", "code_information": [{"code": "G9204", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No reason for no vte", "code_information": [{"code": "G9200", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No rev, comm, track biopsy", "code_information": [{"code": "G8885", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No rh-immunoglobulin order", "code_information": [{"code": "G8811", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No serum creatinine test", "code_information": [{"code": "G8776", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No ster wd ifx", "code_information": [{"code": "G8572", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No strk cabg", "code_information": [{"code": "G8574", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No surg proc w/in 30 days", "code_information": [{"code": "G8628", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "No urine protein test", "code_information": [{"code": "G8773", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Node neg inv brst cncr", "code_information": [{"code": "G8879", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Norsn incomp inf antibio", "code_information": [{"code": "G9302", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Norsn no dicom format doc", "code_information": [{"code": "G9329", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Norsn no pros info op rpt", "code_information": [{"code": "G9303", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Norsn pt cath >=90d", "code_information": [{"code": "G9266", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Not all data norsn", "code_information": [{"code": "G9324", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine Study Of Red Blood Cell, Red Cell Survival, Organ Specific", "code_information": [{"code": "78135", "type": "CPT"}], "standard_charges": [{"minimum": 347.38, "maximum": 347.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 347.38, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 347.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 347.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 347.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 347.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Nursing Facility Annual Assessment, Typically 30 Minutes", "code_information": [{"code": "99318", "type": "CPT"}], "standard_charges": [{"minimum": 84.28, "maximum": 84.28, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 84.28, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 84.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 84.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 84.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 84.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "O.R. 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PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS", "code_information": [{"code": "876", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1421.0, "maximum": 161703.55, "setting": "inpatient", "payers_information": [{"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "standard_charge_dollar": 1421.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 128322.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 161703.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O2 CONTENTS GAS CUBIC FT", "code_information": [{"code": "S8120", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No 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"CPT"}], "standard_charges": [{"minimum": 706.25, "maximum": 706.25, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 706.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 706.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBINUTUZUMAB INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9301", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.1, "maximum": 79.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 79.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 79.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 79.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 79.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 200 ICU 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240406", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 50.4, "maximum": 50.4, "gross_charge": 240.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 212 IP HOLD 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6241820", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 50.4, "maximum": 50.4, "gross_charge": 240.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 215 DOU 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240652", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 50.4, "maximum": 50.4, "gross_charge": 240.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 216 SDU 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240656", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 50.4, "maximum": 50.4, "gross_charge": 240.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 231 M/S 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240614", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 50.4, "maximum": 50.4, "gross_charge": 240.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 235 M/S 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240636", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 50.4, "maximum": 50.4, "gross_charge": 240.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 250 OB 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240620", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 50.4, "maximum": 50.4, "gross_charge": 240.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRIC PANEL", "code_information": [{"code": "80055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 244.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 244.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRIC PANEL", "code_information": [{"code": "80081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 382.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 382.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 74.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 74.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59400", "type": "CPT"}], "standard_charges": [{"minimum": 1756.97, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1756.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1756.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1756.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1756.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1756.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59409", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 764.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 764.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 764.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 764.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 764.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59410", "type": "CPT"}], "standard_charges": [{"minimum": 885.78, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 885.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 885.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 885.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 885.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 885.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBTAIN SCREEN PAP SMEAR", "code_information": [{"code": "Q0091", "type": "HCPCS"}, {"code": "6700091", "type": "CDM"}, {"code": "311", "type": "RC"}], "standard_charges": [{"minimum": 23.38, "maximum": 153.0, "gross_charge": 153.0, "discounted_cash": 114.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 26.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 26.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 26.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCLSN/EMBL CATH CNS", "code_information": [{"code": "4917795", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 44312.0, "discounted_cash": 33234.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OCCLSN/EMBL CATH NON-CNS", "code_information": [{"code": "4917790", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 34052.0, "discounted_cash": 25539.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OCCLUDE FALLOPIAN TUBE(S)", "code_information": [{"code": "58615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCCLUSIVE EYE PATCH", "code_information": [{"code": "A6412", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCCULT BLD FECES ONE SPC", "code_information": [{"code": "82272", "type": "CPT"}, {"code": "4102272", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.57, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLD OTHR SOURCE", "code_information": [{"code": "82271", "type": "CPT"}, {"code": "4102273", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.57, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLD OTHR SOURCE/2", "code_information": [{"code": "82271", "type": "CPT"}, {"code": "4102275", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.57, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLD STL 1-3", "code_information": [{"code": "82270", "type": "CPT"}, {"code": "4102270", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.57, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLOOD STOOL", "code_information": [{"code": "82270", "type": "CPT"}, {"code": "6708734", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.57, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCUPATIONAL THERAPY, IN THE", "code_information": [{"code": "S9129", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCT BREAST SURG CAVITY I&R", "code_information": [{"code": "354T", "type": "CPT"}], "standard_charges": [{"minimum": 971.42, "maximum": 971.42, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 971.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 971.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCT BRST/NODE I&R PER SPEC", "code_information": [{"code": "352T", "type": "CPT"}], "standard_charges": [{"minimum": 971.42, "maximum": 971.42, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 971.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 971.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCT MID EAR I&R BILATERAL", "code_information": [{"code": "486T", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCT MID EAR I&R UNILATERAL", "code_information": [{"code": "485T", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCTAGAM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1568", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.78, "maximum": 47.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCTREOTIDE DEPO PER1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2353", "type": "HCPCS"}, {"code": "5322919", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 183.22, "maximum": 203.58, "gross_charge": 1292.0, "discounted_cash": 969.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 183.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 203.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 203.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 203.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 203.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCTREOTIDE DEPO PER1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2353", "type": "HCPCS"}, {"code": "5322919", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 183.22, "maximum": 203.58, "gross_charge": 1292.0, "discounted_cash": 969.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 183.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 203.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 203.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 203.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 203.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCTREOTIDE PER 25MCG IV IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2354", "type": "HCPCS"}, {"code": "5322920", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}], "modifiers": "JA"}, {"description": "OCTREOTIDE PER 25MCG IV IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2354", "type": "HCPCS"}, {"code": "5322920", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}], "modifiers": "JA"}, {"description": "OCTREOTIDE PER 25MCG SQ IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2354", "type": "HCPCS"}, {"code": "5322948", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}], "modifiers": "JB"}, {"description": "OCTREOTIDE PER 25MCG SQ IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2354", "type": "HCPCS"}, {"code": "5322948", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}], "modifiers": "JB"}, {"description": "OCULAR BLOOD FLOW MEASURE", "code_information": [{"code": "198T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR DEV, INTRAOP, DET RET", "code_information": [{"code": "C1784", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR FUNCTION SCREEN", "code_information": [{"code": "99172", "type": "CPT"}], "standard_charges": [{"minimum": 31.94, "maximum": 36.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR IMP, AQUEOUS DRAIN DE", "code_information": [{"code": "C1783", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCULAR INSTRUMNT SCREEN BIL", "code_information": [{"code": "99174", "type": "CPT"}], "standard_charges": [{"minimum": 12.16, "maximum": 13.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR INSTRUMNT SCREEN BIL", "code_information": [{"code": "99177", "type": "CPT"}], "standard_charges": [{"minimum": 9.86, "maximum": 11.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR PHOTODYNAMIC THER", "code_information": [{"code": "67221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 133.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 133.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 133.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 133.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 133.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65782", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ODONTOPLASTY PER TOOTH", "code_information": [{"code": "D9971", "type": "HCPCS"}], "standard_charges": [{"minimum": 81.67, "maximum": 93.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 84.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFATUMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9302", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.9, "maximum": 68.78, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 61.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 68.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 68.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 68.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 68.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX 70MIN", "code_information": [{"code": "G2086", "type": "HCPCS"}], "standard_charges": [{"minimum": 171.47, "maximum": 196.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 176.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 171.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 196.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 196.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 196.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX, 60 M", "code_information": [{"code": "G2087", "type": "HCPCS"}], "standard_charges": [{"minimum": 171.47, "maximum": 196.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 176.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 171.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 196.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 196.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 196.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CNSLTJ NEW/EST LOW 30", "code_information": [{"code": "99243", "type": "CPT"}], "standard_charges": [{"minimum": 133.45, "maximum": 133.45, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 133.45, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 133.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 133.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 133.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 133.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CNSLTJ NEW/EST MOD 40", "code_information": [{"code": "99244", "type": "CPT"}], "standard_charges": [{"minimum": 194.44, "maximum": 194.44, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 194.44, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 194.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 194.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 194.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 194.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CONSLTJ NEW/EST HI 55", "code_information": [{"code": "99245", "type": "CPT"}], "standard_charges": [{"minimum": 239.5, "maximum": 239.5, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 239.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 239.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 239.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 239.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 239.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CONSLTJ NEW/EST SF 20", "code_information": [{"code": "99242", "type": "CPT"}], "standard_charges": [{"minimum": 97.54, "maximum": 97.54, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 97.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 97.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 97.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 97.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 97.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE EMERGENCY CARE", "code_information": [{"code": "99058", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OH PATCH PERICARDL BOVIN", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8175902", "type": "CDM"}], "standard_charges": [{"minimum": 161.7, "maximum": 161.7, "gross_charge": 770.0, "discounted_cash": 577.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OLANZAPINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308499", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OLANZAPINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308499", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OLANZAPINE 15MG DT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308510", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OLANZAPINE 15MG DT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308510", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OLANZAPINE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308500", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OLANZAPINE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308500", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OLANZAPINE 5MG DT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308506", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "OLANZAPINE 5MG DT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308506", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "OLANZAPINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308497", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OLANZAPINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308497", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OLANZAPINE LONG-ACTING INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2358", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.63, "maximum": 2.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OLIGOCLONAL BANDS", "code_information": [{"code": "83916", "type": "CPT"}, {"code": "7253925", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 102.53, "gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 102.53, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OMALIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2357", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.14, "maximum": 44.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 40.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 44.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 44.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 44.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 44.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OMENTAL FLAP EXTRA-ABDOM", "code_information": [{"code": "49904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1461.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1461.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1461.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1461.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1461.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OMENTAL FLAP INTRA-ABDOM", "code_information": [{"code": "49905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 337.37, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 337.37, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 337.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 337.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 337.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OMEPRAZOLE 20MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308486", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OMEPRAZOLE 20MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308486", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OMEPRAZOLE 2MG/ML 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315908", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OMEPRAZOLE 2MG/ML 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315908", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OMEPRAZOLE 40MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308484", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OMEPRAZOLE 40MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308484", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OMNICARDIOGRAM/CARDIOINTEGRA", "code_information": [{"code": "S9025", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC AML DNA DETCJ/NONDETCJ", "code_information": [{"code": "23U", "type": "CPT"}], "standard_charges": [{"minimum": 248.51, "maximum": 248.51, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 248.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 248.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC B CLL LYMPHM MRNA 58 GEN", "code_information": [{"code": "120U", "type": "CPT"}], "standard_charges": [{"minimum": 2510.21, "maximum": 2510.21, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2510.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2510.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BLADDER MRNA 219 GEN ALG", "code_information": [{"code": "16M", "type": "CPT"}], "standard_charges": [{"minimum": 3489.63, "maximum": 3489.63, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3489.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3489.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BLDR 10 FLWG TRURL RESCJ", "code_information": [{"code": "367U", "type": "CPT"}], "standard_charges": [{"minimum": 902.18, "maximum": 902.18, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 902.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 902.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BLDR 10 PRB BLDR CA", "code_information": [{"code": "365U", "type": "CPT"}], "standard_charges": [{"minimum": 897.0, "maximum": 897.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 897.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 897.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BLDR 10 PRB RECR BLDR CA", "code_information": [{"code": "366U", "type": "CPT"}], "standard_charges": [{"minimum": 897.0, "maximum": 897.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 897.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 897.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 101 GENES", "code_information": [{"code": "153U", "type": "CPT"}], "standard_charges": [{"minimum": 3159.42, "maximum": 3159.42, "setting": "outpatient", "payers_information": [{"payer_name": 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{"description": "ONC BRST CA AI ASSMT 12 FEAT", "code_information": [{"code": "220U", "type": "CPT"}], "standard_charges": [{"minimum": 706.25, "maximum": 706.25, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 706.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 706.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA DNA PIK3CA 11", "code_information": [{"code": "177U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST IMHCHEM PRFL 4 BMRK", "code_information": [{"code": "67U", "type": "CPT"}], "standard_charges": [{"minimum": 1897.0, "maximum": 1897.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1897.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1897.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST MRNA 11 GENES", "code_information": [{"code": "81518", "type": "CPT"}], "standard_charges": [{"minimum": 3873.0, "maximum": 3873.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST MRNA 70 CNT 31 GENE", "code_information": [{"code": "81523", "type": "CPT"}], "standard_charges": [{"minimum": 3873.0, "maximum": 3873.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CHEMO RX CYTOX CSC 14 RX", "code_information": [{"code": "435U", "type": "CPT"}], "standard_charges": [{"minimum": 3033.86, "maximum": 3033.86, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3033.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3033.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT 3 UR METAB ALG PLP", "code_information": [{"code": "2U", "type": "CPT"}], "standard_charges": [{"minimum": 25.0, "maximum": 25.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT CA IMG ALYS W/AI", "code_information": [{"code": "261U", "type": "CPT"}], "standard_charges": [{"minimum": 2513.25, "maximum": 2513.25, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2513.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2513.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT CA MUT&MTHYLTN MRK", "code_information": [{"code": "368U", "type": "CPT"}], "standard_charges": [{"minimum": 416.78, "maximum": 416.78, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT MICRORNA MIR-31-3P", "code_information": [{"code": "69U", "type": "CPT"}], "standard_charges": [{"minimum": 380.0, "maximum": 380.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 380.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT SCR 3 PRTN ALG", "code_information": [{"code": "163U", "type": "CPT"}], "standard_charges": [{"minimum": 390.75, "maximum": 390.75, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT SCR SGL AMP 8 RNA", "code_information": [{"code": "421U", "type": "CPT"}], "standard_charges": [{"minimum": 508.87, "maximum": 508.87, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 508.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 508.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT SCR WHL BLD ALG", "code_information": [{"code": "91U", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 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1950.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1950.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC CUTAN SQ CLL CA MRNA 40", "code_information": [{"code": "315U", "type": "CPT"}], "standard_charges": [{"minimum": 8500.0, "maximum": 8500.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8500.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8500.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DLBCL MRNA 20 GENES ALG", "code_information": [{"code": "17M", "type": "CPT"}], "standard_charges": [{"minimum": 2510.21, "maximum": 2510.21, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", 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"facility"}]}, {"description": "ONC DX BRST STG1-2 NOPROGRES", "code_information": [{"code": "G9072", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG1-2B HR,NOPRO", "code_information": [{"code": "G9071", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG3-HR, NO PRO", "code_information": [{"code": "G9073", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for 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"standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML ACCELER PHASE", "code_information": [{"code": "G9124", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML BLAST PHASE", "code_information": [{"code": "G9125", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML CHRONIC PHASE", "code_information": [{"code": "G9123", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML DX STATUS UNKNOWN", "code_information": [{"code": "G9139", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML REMISSION", "code_information": [{"code": "G9126", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON EXTENT UNKNOWN", "code_information": [{"code": "G9089", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON METAS EVID DX", "code_information": [{"code": "G9087", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON METAS NOEVID DX", "code_information": [{"code": "G9088", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON T1-3,N1-2,NO PR", "code_information": [{"code": "G9084", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON T1-4 NO DX PROG", "code_information": [{"code": "G9086", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON T4, N0 W/O PROG", "code_information": [{"code": "G9085", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAG T1-T3 NOPROG", "code_information": [{"code": "G9096", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAGEAL METS RECUR", "code_information": [{"code": "G9098", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAGEAL T4 NO PROG", "code_information": [{"code": "G9097", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAGEAL UNKNOWN", "code_information": [{"code": "G9099", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC NO RECURRENCE", "code_information": [{"code": "G9100", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC P R1-R2NOPROG", "code_information": [{"code": "G9101", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC RECURRENT", "code_information": [{"code": "G9103", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC UNKNOWN NOS", "code_information": [{"code": "G9104", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC UNRESECTABLE", "code_information": [{"code": "G9102", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK EXT UNKNOWN", "code_information": [{"code": "G9112", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK M1 METS REC", "code_information": [{"code": "G9111", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK T1-T2NO PRG", "code_information": [{"code": "G9109", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK T3-4 NOPROG", "code_information": [{"code": "G9110", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX MULT MYELOMA STG2 HIG", "code_information": [{"code": "G9129", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX MULTI MYELOMA STAGE I", "code_information": [{"code": "G9128", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX MULTI MYELOMA UNKNOWN", "code_information": [{"code": "G9130", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NHL RELAPSE/REFRACTOR", "code_information": [{"code": "G9137", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NHL STG 3-4 NOT RELAP", "code_information": [{"code": "G9135", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NHL STG UNKNOWN", "code_information": [{"code": "G9138", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NHL TRANS TO LG BCELL", "code_information": [{"code": "G9136", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC DX UNKNOWN NOS", "code_information": [{"code": "G9067", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STG2 NO PROGRES", "code_information": [{"code": "G9064", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STG3A NO PROGRE", "code_information": [{"code": "G9065", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STG3B-4 METASTA", "code_information": [{"code": "G9066", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STGI NO PROGRES", "code_information": [{"code": "G9063", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN RECURRENCE", "code_information": [{"code": "G9116", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN STG1A-B NO PR", "code_information": [{"code": "G9113", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN STG1A-B OR 2", "code_information": [{"code": "G9114", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN STG3/4 NOPROG", "code_information": [{"code": "G9115", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN UNKNOWN NOS", "code_information": [{"code": "G9117", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PANCREATC P R0 RES NO", "code_information": [{"code": "G9105", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PANCREATC P R1/R2 NO", "code_information": [{"code": "G9106", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PANCREATIC UNKNWN NOS", "code_information": [{"code": "G9108", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PANCREATIC UNRESECTAB", "code_information": [{"code": "G9107", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE CLINICAL MET", "code_information": [{"code": "G9133", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE METS NO CAST", "code_information": [{"code": "G9132", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE T1NO PROGRES", "code_information": [{"code": "G9077", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE T2NO PROGRES", "code_information": [{"code": "G9078", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE T3B-T4NOPROG", "code_information": [{"code": "G9079", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE UNKNWN NOS", "code_information": [{"code": "G9083", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE W/RISE PSA", "code_information": [{"code": "G9080", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL EXTENT UNKNWN", "code_information": [{"code": "G9095", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL M1 W/METS PROG", "code_information": [{"code": "G9094", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T1-2 NO PROGR", "code_information": [{"code": "G9090", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T1-3,N1-2NOPRG", "code_information": [{"code": "G9092", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T3 N0 NO PROG", "code_information": [{"code": "G9091", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T4,N,M0 NO PRG", "code_information": [{"code": "G9093", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX SCLC/NSCLC EXT AT DX", "code_information": [{"code": "G9069", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX SCLC/NSCLC EXT UNKNWN", "code_information": [{"code": "G9070", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX SCLC/NSCLC LIMITED", "code_information": [{"code": "G9068", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC EXPECTANT MANAGEMENT PT", "code_information": [{"code": "G9053", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC HL NEO GEN SEQ ALYS ALG", "code_information": [{"code": "364U", "type": "CPT"}], "standard_charges": [{"minimum": 2007.25, "maximum": 2007.25, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2007.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2007.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC HL NEO OPT GEN MAPPING", "code_information": [{"code": "331U", "type": "CPT"}], "standard_charges": [{"minimum": 1863.22, "maximum": 1863.22, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1863.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1863.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC HMTLMF NEO JAK2 MUT DNA", "code_information": [{"code": "17U", "type": "CPT"}], "standard_charges": [{"minimum": 91.66, "maximum": 91.66, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 91.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 91.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC HMTLMF NEO RNA BCR/ABL1", "code_information": [{"code": "16U", "type": "CPT"}], "standard_charges": [{"minimum": 163.96, "maximum": 163.96, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 163.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 163.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNCH SYN GEN DNA SEQ ALY", "code_information": [{"code": "238U", "type": "CPT"}], "standard_charges": [{"minimum": 584.9, "maximum": 584.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNG 3 PRTN BMRK PLSM ALG", "code_information": [{"code": "92U", "type": "CPT"}], "standard_charges": [{"minimum": 2488.0, "maximum": 2488.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2488.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNG 5 CLIN RSK FACTR ALG", "code_information": [{"code": "80U", "type": "CPT"}], "standard_charges": [{"minimum": 3520.0, "maximum": 3520.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3520.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3520.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNG MULTIOMICS PLSM ALG", "code_information": [{"code": "401U", "type": "CPT"}], "standard_charges": [{"minimum": 489.68, "maximum": 489.68, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNG MULTIOMICS PLSM ALG", "code_information": [{"code": "403U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LVR SURVEILANC HCC CFDNA", "code_information": [{"code": "333U", "type": "CPT"}], "standard_charges": [{"minimum": 662.32, "maximum": 662.32, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 662.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 662.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MERKEL CLL CARC SRM +/-", "code_information": [{"code": "59U", "type": "CPT"}], "standard_charges": [{"minimum": 322.96, "maximum": 322.96, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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[{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 948.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 948.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MLNMA PRAME & LINC00518", "code_information": [{"code": "89U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MRD NXT-GNRJ ALYS 1ST", "code_information": [{"code": "306U", "type": "CPT"}], "standard_charges": [{"minimum": 3878.45, "maximum": 3878.45, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3878.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3878.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MRD NXT-GNRJ ALYS SBSQ", "code_information": [{"code": "307U", "type": "CPT"}], "standard_charges": [{"minimum": 794.49, "maximum": 794.49, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 794.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 794.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MRNA 5 GEN RECR URTHL CA", "code_information": [{"code": "13M", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MRNA 5 GEN RSK URTHL CA", "code_information": [{"code": "12M", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC NEO XOME&TRNS SEQ ALYS", "code_information": [{"code": "329U", "type": "CPT"}], "standard_charges": [{"minimum": 3437.98, "maximum": 3437.98, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3437.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3437.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC NHLSTG 1-2 NO RELAP NO", "code_information": [{"code": "G9134", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC NONSM CLL LNG CA 37 GEN", "code_information": [{"code": "388U", "type": "CPT"}], "standard_charges": [{"minimum": 3500.0, "maximum": 3500.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3500.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3500.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC NONSM CLL LNG CA ALYS 23", "code_information": [{"code": "179U", "type": "CPT"}], "standard_charges": [{"minimum": 1943.21, "maximum": 1943.21, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1943.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1943.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC ORL&/OROP CA 20 MLC FEAT", "code_information": [{"code": "296U", "type": "CPT"}], "standard_charges": [{"minimum": 1755.0, "maximum": 1755.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1755.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1755.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC OROP/ANAL 17 DNA DDPCR", "code_information": [{"code": "356U", "type": "CPT"}], "standard_charges": [{"minimum": 1800.0, "maximum": 1800.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC OVAR 5 PRTN SER ALG SCOR", "code_information": [{"code": "3U", "type": "CPT"}], "standard_charges": [{"minimum": 950.0, "maximum": 950.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 950.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 950.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC OVRN BCHM ASY 7 PRTN ALG", "code_information": [{"code": "375U", "type": "CPT"}], "standard_charges": [{"minimum": 897.0, "maximum": 897.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 897.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 897.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN CA ALYS MRD PLASMA", "code_information": [{"code": "340U", "type": "CPT"}], "standard_charges": [{"minimum": 3920.0, "maximum": 3920.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3920.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3920.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN SOLID TUM ALYS DNA", "code_information": [{"code": "422U", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM GEN PRFLG 8 DNA", "code_information": [{"code": "332U", "type": "CPT"}], "standard_charges": [{"minimum": 1142.06, "maximum": 1142.06, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1142.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1142.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL GEN OPT MAPG", "code_information": [{"code": "299U", "type": "CPT"}], "standard_charges": [{"minimum": 1863.22, "maximum": 1863.22, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1863.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1863.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL GEN SEQ DNA", "code_information": [{"code": "297U", "type": "CPT"}], "standard_charges": [{"minimum": 2919.6, "maximum": 2919.6, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2919.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2919.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL GEN SEQ&OPT", "code_information": [{"code": "300U", "type": "CPT"}], "standard_charges": [{"minimum": 4183.13, "maximum": 4183.13, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4183.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4183.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL TRNS SEQ RNA", "code_information": [{"code": "298U", "type": "CPT"}], "standard_charges": [{"minimum": 2919.6, "maximum": 2919.6, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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[{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PLSM CELL DO&MYELOMA ID", "code_information": [{"code": "337U", "type": "CPT"}], "standard_charges": [{"minimum": 2435.0, "maximum": 2435.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2435.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2435.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PNCRS DNA&MRNA SEQ 74", "code_information": [{"code": "313U", "type": "CPT"}], "standard_charges": [{"minimum": 3600.0, "maximum": 3600.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PNCRTC 59 MTHLTN BLK MRK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9358", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.98, "maximum": 29.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PNCRTC CA MULT IA ECLIA", "code_information": [{"code": "342U", "type": "CPT"}], "standard_charges": [{"minimum": 897.0, "maximum": 897.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 897.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 897.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRAC COND NOADD BY GUIDE", "code_information": [{"code": "G9061", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRAC GUIDE DIFFERS NOS", "code_information": [{"code": "G9062", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and 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"standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRAC MGMT DIF PT COMORB", "code_information": [{"code": "G9060", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC PRAC MGMT DISAGREE W/GUI", "code_information": [{"code": "G9058", "type": "HCPCS"}], "standard_charges": [{"setting": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 CA ALYS ALL PSA", "code_information": [{"code": "359U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 CA IMG ALYS 128", "code_information": [{"code": "376U", "type": "CPT"}], "standard_charges": [{"minimum": 706.25, "maximum": 706.25, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 706.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 706.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 CA MRNA 12 GEN ALG", "code_information": [{"code": "11M", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 DETCJ 8 AUTOANTB", "code_information": [{"code": "21U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MA MOLEC PRFL ALG", "code_information": [{"code": "228U", "type": "CPT"}], "standard_charges": [{"minimum": 173.03, "maximum": 173.03, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 173.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 173.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MRNA 17 GENE ALG", "code_information": [{"code": "47U", "type": "CPT"}], "standard_charges": [{"minimum": 3873.0, "maximum": 3873.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MRNA HOXC6 & DLX1", "code_information": [{"code": "339U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 PCA3&TMPRSS2-ERG", "code_information": [{"code": "113U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 XOM ALY 442 SNCRNA", "code_information": [{"code": "343U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 XOM ALYS 53 SNCRNA", "code_information": [{"code": "424U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC RNA TISS PREDICT ALG", "code_information": [{"code": "19U", "type": "CPT"}], "standard_charges": [{"minimum": 3675.0, "maximum": 3675.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC RSPS RADJ CLL FR DNA TOX", "code_information": [{"code": "285U", "type": "CPT"}], "standard_charges": [{"minimum": 443.31, "maximum": 443.31, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 443.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 443.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC RSPSE CHEMO CNTRST TOMOG", "code_information": [{"code": "83U", "type": "CPT"}], "standard_charges": [{"minimum": 167.35, "maximum": 167.35, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 167.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2919.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SLD ORGN TGSA DNA 84/+", "code_information": [{"code": "334U", "type": "CPT"}], "standard_charges": [{"minimum": 2919.6, "maximum": 2919.6, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2919.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2919.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM ALYS BRCA1 BRCA2", "code_information": [{"code": "172U", "type": "CPT"}], "standard_charges": [{"minimum": 3030.0, "maximum": 3030.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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[{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM RT-PCR 7 GEN", "code_information": [{"code": "262U", "type": "CPT"}], "standard_charges": [{"minimum": 3200.0, "maximum": 3200.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3200.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SOLID ORGN DNA 257 GENES", "code_information": [{"code": "244U", "type": "CPT"}], "standard_charges": [{"minimum": 3500.0, "maximum": 3500.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3500.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3500.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SOLID TUMOR 30 PRTN TRGT", "code_information": [{"code": "174U", "type": "CPT"}], "standard_charges": [{"minimum": 1305.37, "maximum": 1305.37, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SUPERVISION PALLIATIVE", "code_information": [{"code": "G9054", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC SURVEILLANCE FOR DISEASE", "code_information": [{"code": "G9052", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC THYR 10 MICRORNA SEQ ALG", "code_information": [{"code": "18U", "type": "CPT"}], "standard_charges": [{"minimum": 3002.09, "maximum": 3002.09, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3002.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3002.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC THYR DNA&MRNA 112 GENES", "code_information": [{"code": "26U", "type": "CPT"}], "standard_charges": [{"minimum": 3600.0, "maximum": 3600.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC THYR DNA&MRNA 112 GENES", "code_information": [{"code": "287U", "type": "CPT"}], "standard_charges": [{"minimum": 3600.0, "maximum": 3600.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC THYR MRNA 10,196 GEN ALG", "code_information": [{"code": "81546", "type": "CPT"}], "standard_charges": [{"minimum": 3600.0, "maximum": 3600.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC THYR MUT ALYS 10 GEN&37", "code_information": [{"code": "245U", "type": "CPT"}], "standard_charges": [{"minimum": 1266.07, "maximum": 1266.07, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1266.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 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"ONDANSETRON 2MG/2.5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315903", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ONDANSETRON 2MG/2.5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315903", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ONDANSETRON 4 MG", "code_information": [{"code": "S0119", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.45, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding 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"J8499", "type": "HCPCS"}, {"code": "5308495", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ONDANSETRON 4MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315890", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ONDANSETRON 4MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315890", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ONDANSETRON 8MG DT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": 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"type": "HCPCS"}, {"code": "5308496", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ONDANSETRON ORAL", "code_information": [{"code": "Q0162", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON PER 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315909", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ONDANSETRON PER 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315909", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OOCYTE IDENTIFICATION", "code_information": [{"code": "89254", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OP BRIDGE ON DISCHARGE", "code_information": [{"code": "99213", "type": "CPT"}, {"code": "6409322", "type": "CDM"}, {"code": "513", "type": "RC"}], "standard_charges": [{"minimum": 65.91, "maximum": 65.91, "gross_charge": 152.0, "discounted_cash": 114.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OP CAPD", "code_information": [{"code": "90999", "type": "CPT"}, {"code": "5600232", "type": "CDM"}, {"code": "841", "type": "RC"}], "standard_charges": [{"minimum": 559.86, "maximum": 559.86, "gross_charge": 2666.0, "discounted_cash": 1999.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 559.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OP CCPD", "code_information": [{"code": "90999", "type": "CPT"}, {"code": "5600238", "type": "CDM"}, {"code": "851", "type": "RC"}], "standard_charges": [{"minimum": 559.86, "maximum": 559.86, "gross_charge": 2666.0, "discounted_cash": 1999.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 559.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OP IPD", "code_information": [{"code": "90999", "type": "CPT"}, {"code": "5600228", "type": "CDM"}, {"code": "831", "type": "RC"}], "standard_charges": [{"minimum": 559.86, "maximum": 559.86, "gross_charge": 2666.0, "discounted_cash": 1999.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 559.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN A/V FIST W/O THROMB", "code_information": [{"code": "4915959", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 29664.0, "discounted_cash": 22248.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN ABLATE LIVER TUMOR CRYO", "code_information": [{"code": "47381", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1364.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1364.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1364.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1364.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1364.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN ABLATE LIVER TUMOR RF", "code_information": [{"code": "47380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1333.48, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1333.48, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1333.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1333.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1333.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN AORTIC TUBE PROSTH REPR", "code_information": [{"code": "34830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1888.07, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1888.07, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1888.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1888.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1888.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN AORTOFEMOR PROSTH REPR", "code_information": [{"code": "34832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2046.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2046.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2046.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2046.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2046.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN AORTOILIAC PROSTH REPR", "code_information": [{"code": "34831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1968.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1968.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1968.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1968.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1968.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN BIOPSY OF LUNG PLEURA", "code_information": [{"code": "32098", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN BOWEL TO SKIN", "code_information": [{"code": "44300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 768.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 768.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 768.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 768.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 768.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN BX/EXC INGUINOFEM NODES", "code_information": [{"code": "38531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN CHEST HEART MASSAGE", "code_information": [{"code": "32160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 739.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 739.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 739.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 739.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 739.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN CORONARY ENDARTERECTOMY", "code_information": [{"code": "33572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 234.6, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 234.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 234.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 234.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 234.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN DRAINAGE LIVER LESION", "code_information": [{"code": "47010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1096.99, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1096.99, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1096.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1096.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1096.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN EXC CERV NODE(S) W/ ID", "code_information": [{"code": "C7503", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "35600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 262.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 262.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 262.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 262.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 262.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN ISLET CELL TRANSPLANT", "code_information": [{"code": "586T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN NASOETHMOID FX W/ FIXJ", "code_information": [{"code": "21339", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN NASOETHMOID FX W/O FIXJ", "code_information": [{"code": "21338", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN RED COMP MALAR/ZYGMA FX", "code_information": [{"code": "D7750", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN RED SIMP MALAR/ZYGOM FX", "code_information": [{"code": "D7650", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN RED SIMPL MANDIBLE FX", "code_information": [{"code": "D7630", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUC COMPD ALVEOLUS FX", "code_information": [{"code": "D7770", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCT COMPD MANDBLE FX", "code_information": [{"code": "D7730", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1914.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1914.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1914.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1914.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1914.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1841.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1841.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1841.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1841.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1841.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61314", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1694.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1694.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1694.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1694.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1694.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1948.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1948.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1948.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1948.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1948.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1798.63, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1798.63, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1798.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1798.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1798.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1993.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1993.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1993.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1993.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1993.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR EXPLORATION", "code_information": [{"code": "61304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1548.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1548.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1548.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1548.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1548.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR EXPLORATION", "code_information": [{"code": "61305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1852.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1852.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1852.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1852.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1852.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN THROMBECT AV FISTULA", "code_information": [{"code": "36831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX COMPL FRONT SINUS FX", "code_information": [{"code": "21344", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1483.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1483.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1483.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1483.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1483.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX DPRSD FRONT SINUS FX", "code_information": [{"code": "21343", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1176.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1176.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1176.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1176.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1176.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX ILIAC SPINE UNI/BIL", "code_information": [{"code": "G0412", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE & SEPTAL FX", "code_information": [{"code": "21335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE FX UNCOMPLICATD", "code_information": [{"code": "21325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE FX W/SKELE FIXJ", "code_information": [{"code": "21330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX POST PELVIC FXCTURE", "code_information": [{"code": "G0415", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX SEPTAL FX W/WO STABJ", "code_information": [{"code": "21336", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG INFILTR", "code_information": [{"code": "32096", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG NODULE", "code_information": [{"code": "32097", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST 1ST AR", "code_information": [{"code": "4617236", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 63478.0, "discounted_cash": 47608.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST 1ST AR", "code_information": [{"code": "4917236", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 32077.0, "discounted_cash": 24057.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST 1ST VN", "code_information": [{"code": "4617238", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 96349.0, "discounted_cash": 72261.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST 1ST VN", "code_information": [{"code": "4917238", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 30006.0, "discounted_cash": 22504.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST E/ADD AR", "code_information": [{"code": "4917237", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 27520.0, "discounted_cash": 20640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST E/ADD VN", "code_information": [{"code": "4617239", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 42745.0, "discounted_cash": 32058.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST E/ADD VN", "code_information": [{"code": "4917239", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 27520.0, "discounted_cash": 20640.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT 1ST", "code_information": [{"code": "37236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37237", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37239", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT SAME", "code_information": [{"code": "37238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPH AMD ALYS 3 GENE VARIANTS", "code_information": [{"code": "205U", "type": "CPT"}], "standard_charges": [{"minimum": 47.0, "maximum": 47.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX ANT SGM US UNI/BI", "code_information": [{"code": "76513", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 196.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 196.95, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 103.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 103.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 103.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 103.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 103.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN", "code_information": [{"code": "76512", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 209.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 209.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 113.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 113.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 113.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 113.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 113.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN&QUAN A-SCAN", "code_information": [{"code": "76510", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 268.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 268.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 173.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 173.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 173.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 173.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 173.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 111.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 111.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX QUAN A-SCAN ONLY", "code_information": [{"code": "76511", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 232.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 232.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC BIOMETRY", "code_information": [{"code": "92136", "type": "CPT"}], "standard_charges": [{"minimum": 91.72, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 91.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 91.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 91.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 91.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 91.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC ENDOSCOPE ADD-ON", "code_information": [{"code": "66990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 81.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 81.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 81.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 81.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 81.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPHTHALMODYNAMOMETRY", "code_information": [{"code": "92260", "type": "CPT"}], "standard_charges": [{"minimum": 18.18, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIATES/3", "code_information": [{"code": "80361", "type": "CPT"}, {"code": "7253926", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 779.0, "discounted_cash": 584.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOIDS & OPIATE ANALOGS 3/4", "code_information": [{"code": "80363", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOIDS/OPIATE ANALOGS 1/2", "code_information": [{"code": "80362", "type": "CPT"}, {"code": "7250001", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 1397.0, "discounted_cash": 1047.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOIDS/OPIATE ANALOGS 5+", "code_information": [{"code": "80364", "type": "CPT"}, {"code": "7250387", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 1397.0, "discounted_cash": 1047.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIUM 10% TINC PER DS LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327831", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OPIUM 10% TINC PER DS LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327831", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS", "code_information": [{"code": "34715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS CNDT", "code_information": [{"code": "34716", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN BRACH ART EXPOS", "code_information": [{"code": "34834", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 291.64, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 291.64, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 291.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 291.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 291.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS", "code_information": [{"code": "34812", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 355.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 355.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 355.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 355.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 355.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS CNDT CRTJ", "code_information": [{"code": "34714", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN ILAC ART EXPOS CNDT CRTJ", "code_information": [{"code": "34833", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 637.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 637.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 637.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 637.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 637.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN ILIAC ART EXPOS", "code_information": [{"code": "34820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 508.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 508.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 508.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 508.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 508.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ CRNL NRV NEA&PG", "code_information": [{"code": "64568", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ NEA NEUROMUSCULAR", "code_information": [{"code": "64580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ NEA PERPH NERVE", "code_information": [{"code": "64575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ NEA SACRAL NERVE", "code_information": [{"code": "64581", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4911.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN INSJ/RPLCMT INS PTN SUBF", "code_information": [{"code": "817T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN INSJ/RPLCMT INS PTN SUBQ", "code_information": [{"code": "816T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN MPLTJ HPGLSL NSTM ARY PG", "code_information": [{"code": "64582", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX COMPLX MALAR FX", "code_information": [{"code": "21365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1073.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1073.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1073.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1073.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1073.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX COMPLX MALAR W/GRFT", "code_information": [{"code": "21366", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1207.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1207.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1207.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1207.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1207.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX DPRSD MALAR FRACTURE", "code_information": [{"code": "21360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX DPRSD ZYGOMATIC ARCH", "code_information": [{"code": "21356", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX MULTPLE", "code_information": [{"code": "21347", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1143.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1143.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1143.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1143.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1143.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX W/FIXJ", "code_information": [{"code": "21346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 951.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 951.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 951.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 951.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 951.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX W/GRAFT", "code_information": [{"code": "21348", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1176.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1176.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1176.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1176.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1176.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX COMBINED", "code_information": [{"code": "21387", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 751.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 751.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 751.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 751.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 751.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX PERIORBITAL", "code_information": [{"code": "21386", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 653.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 653.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 653.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 653.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 653.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX TRANSANTRAL", "code_information": [{"code": "21385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 706.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 706.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 706.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 706.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 706.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/BONE GRFT", "code_information": [{"code": "21408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 851.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 851.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 851.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 851.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 851.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/IMPLANT", "code_information": [{"code": "21407", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/O IMPLANT", "code_information": [{"code": "21406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT PERIORBT W/GRFT", "code_information": [{"code": "21395", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 942.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 942.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 942.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 942.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 942.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT PERIORBTL IMPLT", "code_information": [{"code": "21390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPPS SERVICE,SCHED TEAM CONF", "code_information": [{"code": "G0175", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPRELVEKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2355", "type": "HCPCS"}], "standard_charges": [{"minimum": 384.23, "maximum": 426.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 384.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 426.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 426.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 426.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 426.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPSCPY EXTND ON/MAC DRAW", "code_information": [{"code": "92202", "type": "CPT"}], "standard_charges": [{"minimum": 71.81, "maximum": 82.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 71.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 82.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 82.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 82.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPSCPY EXTND RTA DRAW UNI/BI", "code_information": [{"code": "92201", "type": "CPT"}], "standard_charges": [{"minimum": 71.81, "maximum": 82.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 71.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 82.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 82.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 82.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTHAL EXAM W/ANES COMP", "code_information": [{"code": "92018", "type": "CPT"}, {"code": "3212018", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "gross_charge": 7798.0, "discounted_cash": 5848.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1637.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 7408.1, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 131.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 131.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 7408.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 131.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 131.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 131.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2877.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 5848.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 5848.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTHAL EXAM W/ANES LTD", "code_information": [{"code": "92019", "type": "CPT"}, {"code": "3212019", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2823.29, "gross_charge": 10968.0, "discounted_cash": 8226.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 66.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2541.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2468.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2823.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2823.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2823.29, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 66.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 66.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 66.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 66.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTHAL EXAM W/ANES LTD", "code_information": [{"code": "92019", "type": "CPT"}, {"code": "3212019", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2823.29, "gross_charge": 10968.0, "discounted_cash": 8226.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 66.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE 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"plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 66.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 66.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTIC FORAMINA", "code_information": [{"code": "70190", "type": "CPT"}, {"code": "4900190", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 193.62, "gross_charge": 922.0, "discounted_cash": 691.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 193.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.78, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTIC FORAMINA", "code_information": [{"code": "70190", "type": "CPT"}, {"code": "5010190", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 193.62, "gross_charge": 922.0, "discounted_cash": 691.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 193.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.78, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTICAL ENDOMICROSCPY INTERP", "code_information": [{"code": "88375", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 186.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 186.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTO-ACOUSTIC IMG BREAST UNI", "code_information": [{"code": "857T", "type": "CPT"}], "standard_charges": [{"minimum": 104.75, "maximum": 104.75, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 104.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 104.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92544", "type": "CPT"}], "standard_charges": [{"minimum": 54.42, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX ACRCLV DSLC AQ/CHRN GRF", "code_information": [{"code": "23552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX ACROMCLV DISLC AQT/CHRN", "code_information": [{"code": "23550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX ACUTE SHOULDER DISLC", "code_information": [{"code": "23660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX CLAVICULAR FX W/INT FIX", "code_information": [{"code": "23515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 40098.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX GR HMRL TBRS FX INT FIX", "code_information": [{"code": "23630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX MEDIAL ANKLE FX", "code_information": [{"code": "27766", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX OF RIB FX W/FIXJ SCOPE", "code_information": [{"code": "21811", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX POST ANKLE FX", "code_information": [{"code": "27769", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX PROX HUMRL FX W/INT FIX", "code_information": [{"code": "23615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX PRX HMRL FX FIX RPR RPL", "code_information": [{"code": "23616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX SCAPULAR FX W/INT FIXJ", "code_information": [{"code": "23585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX SHO DISLC FX", "code_information": [{"code": "23670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX SHO DISLC NECK FX FIXJ", "code_information": [{"code": "23680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX STRCLV DSLC AQ/CHRN GRF", "code_information": [{"code": "23532", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX STRNCLAV DISLC AQT/CHRN", "code_information": [{"code": "23530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX THIGH FX", "code_information": [{"code": "27269", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1183.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1183.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1183.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1183.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1183.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORAL BUSULFAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8510", "type": "HCPCS"}], "standard_charges": [{"minimum": 140.94, "maximum": 156.6, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 140.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 156.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 156.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 156.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 156.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL FLUDARABINE PHOSPHATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8562", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.59, "maximum": 81.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 73.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 81.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 81.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 81.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL FUNCTION THERAPY", "code_information": [{"code": "92526", "type": "CPT"}], "standard_charges": [{"minimum": 75.87, "maximum": 198.42, "estimated_discounted_cash": 810.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 75.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 178.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 173.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 198.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 198.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 198.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 75.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 75.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 75.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 75.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0435", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.98, "maximum": 11.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL MED ADM DIRECT OBSERVE", "code_information": [{"code": "H0033", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL MR CONTRAST, 100 ML", "code_information": [{"code": "Q9954", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL NETUPITANT, PALONOSETRO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8655", "type": "HCPCS"}], "standard_charges": [{"minimum": 380.6, "maximum": 422.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 380.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 422.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 422.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 422.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 422.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL SPEECH DEVICE EVAL", "code_information": [{"code": "92597", "type": "CPT"}], "standard_charges": [{"minimum": 145.12, "maximum": 165.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBICULARIS OCULI REFLEX", "code_information": [{"code": "95933", "type": "CPT"}, {"code": "4705933", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 72.39, "maximum": 165.85, "gross_charge": 1598.0, "discounted_cash": 1198.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "113", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3735.01, "maximum": 98367.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13259.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21684.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9099.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6166.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13951.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22816.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9574.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6488.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14732.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6851.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10110.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24093.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10110.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6851.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14732.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24093.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10110.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14732.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6851.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24093.96, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5607.08, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9779.12, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 21837.33, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 3735.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 78061.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 98367.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "114", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5063.07, "maximum": 56608.17, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 28308.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7296.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10070.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16173.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29786.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7677.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10596.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17018.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11189.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 31453.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8107.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17970.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11189.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 31453.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17970.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8107.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 31453.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11189.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8107.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17970.62, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6118.47, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 23732.88, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5063.07, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13627.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44922.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 56608.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61584", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2693.37, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2693.37, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2693.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2693.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2693.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2848.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2848.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2848.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2848.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2848.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2996.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2996.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2996.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2996.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2996.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITS 4VW MIN", "code_information": [{"code": "70200", "type": "CPT"}, {"code": "4900152", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 280.35, "gross_charge": 1335.0, "discounted_cash": 1001.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 280.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 102.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITS 4VW MIN", "code_information": [{"code": "70200", "type": "CPT"}, {"code": "5010152", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 280.35, "gross_charge": 1335.0, "discounted_cash": 1001.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 280.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 102.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORCHIECTOMY PARTIAL", "code_information": [{"code": "54522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 22752.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORCHIOPEXY (FOWLER-STEPHENS)", "code_information": [{"code": "54650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 707.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 707.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 707.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 707.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 707.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORCHIOPEXY INGUN/SCROT APPR", "code_information": [{"code": "54640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 11914.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACID SNG QNT", "code_information": [{"code": "83921", "type": "CPT"}, {"code": "7252125", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.95, "gross_charge": 122.0, "discounted_cash": 91.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.95, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACID SNG QNT/4", "code_information": [{"code": "83921", "type": "CPT"}, {"code": "7258426", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.95, "gross_charge": 305.0, "discounted_cash": 228.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 83.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACIDS QUAL", "code_information": [{"code": "83919", "type": "CPT"}, {"code": "7258391", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.95, "gross_charge": 237.0, "discounted_cash": 177.75, "setting": "both", "payers_information": [{"payer_name": 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"billing_class": "facility"}]}, {"description": "OSELTAMIVIR 75MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308504", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "OSMOLALITY BLOOD", "code_information": [{"code": "83930", "type": "CPT"}, {"code": "4103930", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.73, "gross_charge": 108.0, "discounted_cash": 81.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.73, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSMOLALITY BLOOD", "code_information": [{"code": "83930", "type": "CPT"}, {"code": "7253930", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.73, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.73, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSMOLALITY FECAL", "code_information": [{"code": "84999", "type": "CPT"}, {"code": "7250168", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "gross_charge": 304.0, "discounted_cash": 228.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSMOLALITY URINE", "code_information": [{"code": "83935", "type": "CPT"}, {"code": "4103935", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.75, "gross_charge": 156.0, "discounted_cash": 117.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSMOLALITY URINE", "code_information": [{"code": "83935", "type": "CPT"}, {"code": "7253935", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.75, "gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.75, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSMOTIC FRAG RBC INC", "code_information": [{"code": "85557", "type": "CPT"}, {"code": "7255557", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.11, "gross_charge": 161.0, "discounted_cash": 120.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 68.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.36, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSMOTIC FRAG RBC UNINC", "code_information": [{"code": "85555", "type": "CPT"}, {"code": "7255555", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.09, "gross_charge": 813.0, "discounted_cash": 609.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOART ALGRFT W/SURF & B1", "code_information": [{"code": "20932", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOCALCIN", "code_information": [{"code": "83937", "type": "CPT"}, {"code": "7253938", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 152.24, "gross_charge": 455.0, "discounted_cash": 341.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 152.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL KNEE ALLOGRAFT", "code_information": [{"code": "27415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1366.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1366.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1366.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1366.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1366.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL KNEE AUTOGRAFT", "code_information": [{"code": "27416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL TALUS AUTOGRFT", "code_information": [{"code": "28446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITH CC", "code_information": [{"code": "540", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9382.52, "maximum": 54235.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12081.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 31256.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14716.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18601.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12712.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15485.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 32889.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19572.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 20668.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13423.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 34730.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16351.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16351.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 20668.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13423.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 34730.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13423.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20668.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 34730.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16351.68, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11979.94, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 24364.3, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9382.52, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 15567.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43039.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 54235.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITH MCC", "code_information": [{"code": "539", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9129.44, "maximum": 82410.28, "estimated_discounted_cash": 44908.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 41592.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20098.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14220.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12311.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43765.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14963.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12954.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21148.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 22331.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 46214.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15800.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13679.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 22331.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 46214.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15800.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13679.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 46214.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 22331.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15800.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13679.8, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9129.44, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10757.55, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16210.69, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 30185.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 65397.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 82410.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITHOUT CC/MCC", "code_information": [{"code": "541", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9053.77, "maximum": 32944.03, "estimated_discounted_cash": 46743.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16090.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12542.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13070.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21638.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16931.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13197.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22768.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13753.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24042.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14523.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17878.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13936.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13936.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17878.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24042.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14523.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14523.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24042.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13936.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17878.78, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13739.82, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 20241.83, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9053.77, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10821.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26143.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32944.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 1-2 REGIONS", "code_information": [{"code": "98925", "type": "CPT"}], "standard_charges": [{"minimum": 29.77, "maximum": 41.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 41.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 41.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 41.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 3-4 REGIONS", "code_information": [{"code": "98926", "type": "CPT"}], "standard_charges": [{"minimum": 33.75, "maximum": 41.04, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 5-6 REGIONS", "code_information": [{"code": "98927", "type": "CPT"}], "standard_charges": [{"minimum": 33.75, "maximum": 52.7, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 7-8 REGIONS", "code_information": [{"code": "98928", "type": "CPT"}], "standard_charges": [{"minimum": 33.75, "maximum": 61.68, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 61.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 61.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 61.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 61.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 9-10 REGIONS", "code_information": [{"code": "98929", "type": "CPT"}], "standard_charges": [{"minimum": 36.5, "maximum": 70.67, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 70.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 41.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 41.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 41.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 70.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 70.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 70.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 70.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1 VRT SGM CRV", "code_information": [{"code": "22220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1548.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1548.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1548.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1548.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1548.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM EA", "code_information": [{"code": "22226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 368.37, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 368.37, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 368.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 368.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 368.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM LMBR", "code_information": [{"code": "22224", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1530.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1530.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1530.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1530.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1530.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM THRC", "code_information": [{"code": "22222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1400.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1400.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1400.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1400.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1400.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOT HUM XTRNL LNGTH DEV", "code_information": [{"code": "594T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTOMY SUPPLY MISC", "code_information": [{"code": "A4421", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OT AQUA THER W/EXER EA15", "code_information": [{"code": "97113", "type": "CPT"}, {"code": "6051904", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 28.77, "maximum": 90.82, "gross_charge": 409.0, "discounted_cash": 306.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 79.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 90.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 90.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 90.82, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT AQUATC THPY W/EX 15", "code_information": [{"code": "97113", "type": "CPT"}, {"code": "5805304", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 306.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT COG FUNC ACTIVITY ADDL 15M", "code_information": [{"code": "97130", "type": "CPT"}, {"code": "6057137", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT COG FUNC ACTIVITY INIT 15M", "code_information": [{"code": "97129", "type": "CPT"}, {"code": "5807129", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT COG FUNC ACTIVITY INIT 15M", "code_information": [{"code": "97129", "type": "CPT"}, {"code": "6057116", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT COG FUNC ACTIVTY ADDL 15M", "code_information": [{"code": "97130", "type": "CPT"}, {"code": "5807130", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT COMM/WK REINT TRNG 15", "code_information": [{"code": "97537", "type": "CPT"}, {"code": "5805320", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 374.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT E-STIM BASIC", "code_information": [{"code": "G0283", "type": "HCPCS"}, {"code": "5800283", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 339.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT E-STIM BASIC", "code_information": [{"code": "G0283", "type": "HCPCS"}, {"code": "6057021", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT E-STIM MAN EA 15 BSC", "code_information": [{"code": "97032", "type": "CPT"}, {"code": "5805266", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 372.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT E-STIM MAN EA 15 BSC", "code_information": [{"code": "97032", "type": "CPT"}, {"code": "6051866", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 372.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT EVAL HIGH COMP", "code_information": [{"code": "97167", "type": "CPT"}, {"code": "5805205", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 1691.0, "discounted_cash": 1268.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT EVAL HIGH COMP", "code_information": [{"code": "97167", "type": "CPT"}, {"code": "6051807", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 1691.0, "discounted_cash": 1268.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT EVAL HIGH COMPLEX 60 MIN", "code_information": [{"code": "97167", "type": "CPT"}], "standard_charges": [{"minimum": 185.53, "maximum": 212.17, "estimated_discounted_cash": 1580.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 212.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 212.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 212.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT EVAL LOW COMP", "code_information": [{"code": "97165", "type": "CPT"}, {"code": "5805201", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 1691.0, "discounted_cash": 1268.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT EVAL LOW COMP", "code_information": [{"code": "97165", "type": "CPT"}, {"code": "6051801", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 1691.0, "discounted_cash": 1268.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT EVAL LOW COMPLEX 30 MIN", "code_information": [{"code": "97165", "type": "CPT"}], "standard_charges": [{"minimum": 185.53, "maximum": 212.17, "estimated_discounted_cash": 1596.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 212.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 212.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 212.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT EVAL LOW COMPLX 20M-TELEMED", "code_information": [{"code": "97165", "type": "CPT"}, {"code": "5807165", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 553.0, "discounted_cash": 414.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|95"}, {"description": "OT EVAL LOW COMPLX 20M-TELEMED", "code_information": [{"code": "97165", "type": "CPT"}, {"code": "6057165", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 553.0, "discounted_cash": 414.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|95"}, {"description": "OT EVAL MOD COMP", "code_information": [{"code": "97166", "type": "CPT"}, {"code": "5805203", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 1691.0, "discounted_cash": 1268.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT EVAL MOD COMP", "code_information": [{"code": "97166", "type": "CPT"}, {"code": "6051803", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 1691.0, "discounted_cash": 1268.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT EVAL MOD COMPLEX 45 MIN", "code_information": [{"code": "97166", "type": "CPT"}], "standard_charges": [{"minimum": 185.53, "maximum": 212.17, "estimated_discounted_cash": 1610.27, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 212.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 212.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 212.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT EVAL MOD COMPLX 30M-TELEMED", "code_information": [{"code": "97166", "type": "CPT"}, {"code": "5807166", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 553.0, "discounted_cash": 414.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|95"}, {"description": "OT EVAL MOD COMPLX 30M-TELEMED", "code_information": [{"code": "97166", "type": "CPT"}, {"code": "6057166", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 553.0, "discounted_cash": 414.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|95"}, {"description": "OT IONTOPHOR EA 15 BSC", "code_information": [{"code": "97033", "type": "CPT"}, {"code": "5805272", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 658.0, "discounted_cash": 493.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT IONTOPHOR EA 15 BSC", "code_information": [{"code": "97033", "type": "CPT"}, {"code": "6051872", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 658.0, "discounted_cash": 493.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT MANUAL THERAPY EA 15M", "code_information": [{"code": "97140", "type": "CPT"}, {"code": "5805180", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 518.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT MANUAL THERAPY EA 15M", "code_information": [{"code": "97140", "type": "CPT"}, {"code": "6055180", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 518.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT NEUROMUSC RE-ED 15M-TELEMED", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "5807112", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 193.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|95"}, {"description": "OT NEUROMUSC RE-ED 15M-TELEMED", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "6057102", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 193.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|95"}, {"description": "OT NEUROMUSC RE-ED EA15", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "6051900", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 193.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT NEUROMUSC RE-EDUC EA15", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "5805300", "type": "CDM"}, {"code": "430", "type": "RC"}], 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"standard_charges": [{"gross_charge": 427.0, "discounted_cash": 320.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CO"}, {"description": "OTA THERAPEUTC ACT EA 15M #2", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "6050216", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 306.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CO"}, {"description": "OTA THERAPTC ACT EA 15", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "5800034", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 306.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CO"}, {"description": "OTA THERAPTC EXER EA 15", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "5800026", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 320.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CO"}, {"description": "OTA THERAPTC MASSGE EA15", "code_information": [{"code": "97124", "type": "CPT"}, {"code": "5800032", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CO"}, {"description": "OTA US EA 15 BASIC", "code_information": [{"code": "97035", "type": "CPT"}, {"code": "5800025", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 371.0, "discounted_cash": 278.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CO"}, {"description": "OTA US EA15 BSC", "code_information": [{"code": "97035", "type": "CPT"}, {"code": "6050224", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 371.0, "discounted_cash": 278.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CO"}, {"description": "OTA WHIRLPOOL COMPLX", "code_information": [{"code": "97022", "type": "CPT"}, {"code": "6050205", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 277.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CO"}, {"description": "OTA WHIRLPOOL EXTNSV", "code_information": [{"code": "97022", "type": "CPT"}, {"code": "5800004", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CO"}, {"description": "OTA WHIRLPOOL INTERM", "code_information": [{"code": "97022", "type": "CPT"}, {"code": "6050207", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 739.0, "discounted_cash": 554.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CO"}, {"description": "OTH RESP PROC, GROUP", "code_information": [{"code": "G0239", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTH RESP PROC, INDIV", "code_information": [{"code": "G0238", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.0, "maximum": 34.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 34.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 34.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 34.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "818", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38487.76, "maximum": 48499.77, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38487.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 48499.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "817", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7217.86, "maximum": 95459.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7217.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26841.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14785.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9099.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9574.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7594.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 28243.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15557.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16428.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8019.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10110.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29824.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29824.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10110.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8019.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16428.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29824.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10110.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8019.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16428.57, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7582.21, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 14128.58, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 23530.67, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10220.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 75753.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 95459.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "819", "type": "MS-DRG"}], "standard_charges": [{"minimum": 28550.4, "maximum": 35977.36, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28550.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35977.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC", "code_information": [{"code": "832", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23958.56, "maximum": 30191.02, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23958.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30191.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC", "code_information": [{"code": "831", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39925.4, "maximum": 50311.4, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39925.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 50311.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "833", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17361.33, "maximum": 21877.61, "estimated_discounted_cash": 30390.64, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17361.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21877.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER BONE GRAFT MICROVASC", "code_information": [{"code": "20962", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2637.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2637.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2637.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2637.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2637.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [{"code": "228", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 206994.27, "estimated_discounted_cash": 210619.36, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21759.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29630.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 50974.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16874.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31178.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO 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combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "P/M AICD ELECTRD RPR", "code_information": [{"code": "4613218", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16992.0, "discounted_cash": 12744.0, "setting": "both", "billing_class": "facility"}]}, {"description": "P32 CHROMIC PHOSPHATE", "code_information": [{"code": "A9564", "type": "HCPCS"}], "standard_charges": [{"minimum": 448.02, "maximum": 497.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 448.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 497.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 497.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 497.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 497.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "P32 NA PHOSPHATE", "code_information": [{"code": "A9563", "type": "HCPCS"}], "standard_charges": [{"minimum": 470.25, "maximum": 522.38, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 470.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 522.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 522.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 522.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 522.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PABPN1 GENE DETC ABNOR ALLEL", "code_information": [{"code": "81312", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PACLITAX PRTBD PER 1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9264", "type": "HCPCS"}, {"code": "5323052", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 9.49, "maximum": 10.54, "gross_charge": 63.0, "discounted_cash": 47.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PACLITAX PRTBD PER 1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9264", "type": "HCPCS"}, {"code": "5323052", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.49, "maximum": 10.54, "gross_charge": 63.0, "discounted_cash": 47.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAD EXERCISE THERAPY SUP", "code_information": [{"code": "93668", "type": "CPT"}, {"code": "6013668", "type": "CDM"}, {"code": "943", "type": "RC"}], "standard_charges": [{"minimum": 19.17, "maximum": 87.14, "gross_charge": 468.0, "discounted_cash": 351.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.14, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PADDING FOR COMPRSSN BDG", "code_information": [{"code": "S8430", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PAIN MGMT 11 ENDOGENOUS ANAL", "code_information": [{"code": "117U", "type": "CPT"}], "standard_charges": [{"minimum": 840.65, "maximum": 840.65, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAIN MGMT MRNA GEN XPRSN 36", "code_information": [{"code": "290U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALB2 GENE FULL GENE SEQ", "code_information": [{"code": "81307", "type": "CPT"}], "standard_charges": [{"minimum": 676.5, "maximum": 676.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 676.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 676.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALB2 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81308", "type": "CPT"}], "standard_charges": [{"minimum": 301.35, "maximum": 301.35, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALB2 MRNA SEQ ALYS", "code_information": [{"code": "137U", "type": "CPT"}], "standard_charges": [{"minimum": 282.88, "maximum": 282.88, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIFERMIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2425", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.0, "maximum": 35.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 35.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 35.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 35.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 35.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIVIZUMAB PER 50MG IJ", "code_information": [{"code": "90378", "type": "CPT"}, {"code": "5323057", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1868.0, "maximum": 2075.55, "gross_charge": 9736.0, "discounted_cash": 7302.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1868.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2075.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2075.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2075.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2075.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIVIZUMAB PER 50MG IJ", "code_information": [{"code": "90378", "type": "CPT"}, {"code": "5323057", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1868.0, "maximum": 2075.55, "gross_charge": 9736.0, "discounted_cash": 7302.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1868.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2075.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2075.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2075.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2075.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G0031", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PALL SERV DURING MEAS", "code_information": [{"code": "G0034", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANCREAS REMOVAL/TRANSPLANT", "code_information": [{"code": "48160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS TRANSPLANT", "code_information": [{"code": "10", "type": "MS-DRG"}], "standard_charges": [{"minimum": 238247.59, "maximum": 300224.11, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 238247.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 300224.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC", "code_information": [{"code": "406", "type": "MS-DRG"}], "standard_charges": [{"minimum": 96292.44, "maximum": 121341.47, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 96292.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 121341.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "405", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14870.88, "maximum": 228880.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27645.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 41988.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83323.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24517.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 87675.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29089.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 44181.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25798.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30717.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27242.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 92582.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 46654.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30717.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 46654.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27242.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 92582.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27242.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30717.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 92582.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 46654.42, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 14870.88, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 68372.93, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 36534.71, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 18748.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 181631.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 228880.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "407", "type": "MS-DRG"}], "standard_charges": [{"minimum": 73695.16, "maximum": 92865.84, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 73695.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 92865.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1694.04, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1694.04, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1694.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1694.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1694.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48152", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2635.18, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2635.18, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2635.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2635.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2635.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48153", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2847.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2847.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2847.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2847.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2847.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48154", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2649.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2649.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2649.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2649.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2649.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATORRHAPHY", "code_information": [{"code": "48545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1203.33, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1203.33, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1203.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1203.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1203.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCRELIP 20-63-84 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306615", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PANCRELIP 20-63-84 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306615", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PANCRELIP 5-17-24 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306614", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PANCRELIP 5-17-24 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306614", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PANCRELIP 5-17-27 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306601", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PANCRELIP 5-17-27 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306601", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PANITUMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9303", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.73, "maximum": 173.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 155.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 173.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 173.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 173.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 173.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANORAMIC X-RAY OF JAWS", "code_information": [{"code": "70355", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 80.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANTOPRAZOLE 40MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308870", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PANTOPRAZOLE 40MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308870", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PANTOPRAZOLE 40MG LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5323071", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PANTOPRAZOLE 40MG LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5323071", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAP SMEAR SCREENING", "code_information": [{"code": "G0123", "type": "HCPCS"}, {"code": "4300123", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 103.33, "gross_charge": 451.0, "discounted_cash": 338.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 94.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 103.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARAFFIN BATH THERAPY", "code_information": [{"code": "97018", "type": "CPT"}], "standard_charges": [{"minimum": 6.57, "maximum": 16.75, "estimated_discounted_cash": 233.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARAINFLUENZA DFA", "code_information": [{"code": "87279", "type": "CPT"}, {"code": "7257298", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 308.0, "discounted_cash": 231.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARAMED INTRCEPT NONVOL", "code_information": [{"code": "S0208", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARAMEDICINTERCEP NONHOSPALS", "code_information": [{"code": "S0207", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARANASAL SINUS ULTRASOUND", "code_information": [{"code": "S9024", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARATHORMONE (PTH)", "code_information": [{"code": "83970", "type": "CPT"}, {"code": "4103970", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 210.5, "gross_charge": 622.0, "discounted_cash": 466.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 210.5, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.67, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYRD IMG W/SPECT", "code_information": [{"code": "78071", "type": "CPT"}, {"code": "5208071", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1319.07, "gross_charge": 4521.0, "discounted_cash": 3390.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 949.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1319.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYRD PLANAR W/SPECT&CT", "code_information": [{"code": "78072", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 1519.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1519.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYROID IMAGING", "code_information": [{"code": "78070", "type": "CPT"}, {"code": "5208031", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 567.63, "gross_charge": 2703.0, "discounted_cash": 2027.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 567.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 508.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 217.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 217.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 217.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 217.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 217.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARENTERAL SOL HEPATIC FREAM", "code_information": [{"code": "B5200", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.09, "maximum": 0.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARENTING CLASS", "code_information": [{"code": "S9444", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARIETAL CELL AB", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "7258658", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.84, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.84, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARING/CUTG B9 HYPRKER LES 1", "code_information": [{"code": "11055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4520.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARNG/CUTG B9 HYPRKR LES 2-4", "code_information": [{"code": "11056", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6043.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARNG/CUTG B9 HYPRKR LES >4", "code_information": [{"code": "11057", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3347.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42507", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42509", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAROXETINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308949", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAROXETINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308949", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAROXETINE 10MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315960", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PAROXETINE 10MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315960", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PAROXETINE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308950", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAROXETINE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308950", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAROXETINE PER 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315969", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PAROXETINE PER 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315969", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PART REMOVAL FINGER BONE", "code_information": [{"code": "6900136", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5043.0, "discounted_cash": 3782.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PART REMOVAL FINGER BONE", "code_information": [{"code": "6900136", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 5043.0, "discounted_cash": 3782.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PART REMOVAL HIP BONE DEEP", "code_information": [{"code": "27071", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 904.63, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 904.63, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 904.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 904.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 904.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF ANKLE/HEEL", "code_information": [{"code": "28120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "estimated_discounted_cash": 12422.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 16552.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12261.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10287.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15139.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVE HIP BONE SUPER", "code_information": [{"code": "27070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 838.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 838.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 838.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 838.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 838.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART RMVL OF TOE JOINT", "code_information": [{"code": "6900138", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10253.0, "discounted_cash": 7689.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PART RMVL OF TOE JOINT", "code_information": [{"code": "6900138", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 10253.0, "discounted_cash": 7689.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PARTIAL AMPUTATION OF TOE", "code_information": [{"code": "28825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXC BONE HUMERUS", "code_information": [{"code": "24140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL HIP REPLACEMENT", "code_information": [{"code": "27125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1103.78, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1103.78, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1103.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1103.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1103.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL HOSP 1/2 DAY", "code_information": [{"code": "H0035", "type": "HCPCS"}, {"code": "6424221", "type": "CDM"}, {"code": "913", "type": "RC"}], "standard_charges": [{"gross_charge": 1624.0, "discounted_cash": 1218.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PARTIAL HOSP <24HRS IOP", "code_information": [{"code": "H0035", "type": "HCPCS"}, {"code": "6424220", "type": "CDM"}, {"code": "913", "type": "RC"}], "standard_charges": [{"gross_charge": 1400.0, "discounted_cash": 1050.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PARTIAL HOSPITALIZATION SERV", "code_information": [{"code": "S0201", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL HYSTERECTOMY", "code_information": [{"code": "58180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 929.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 929.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 929.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 929.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 929.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL MASTECTOMY", "code_information": [{"code": "19301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18694.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1790.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1790.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1790.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1790.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1790.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45123", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1011.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1011.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1011.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1011.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1011.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL RELEASE OF LUNG", "code_information": [{"code": "32225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 977.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 977.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 977.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 977.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 977.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL COLLAR BONE", "code_information": [{"code": "23120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3187.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3187.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3187.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3187.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3187.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3792.12, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3792.12, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3792.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3792.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3792.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47142", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4168.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4168.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4168.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4168.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4168.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FINGER BONE", "code_information": [{"code": "26235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FINGER BONE", "code_information": [{"code": "26236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FOOT FASCIA", "code_information": [{"code": "28060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL LEG BONE(S)", "code_information": [{"code": "27360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF BLADDER", "code_information": [{"code": "51550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 978.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 978.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 978.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 978.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 978.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF BLADDER", "code_information": [{"code": "51555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1298.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1298.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1298.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1298.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1298.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1232.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1232.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1232.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1232.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1232.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1595.6, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1595.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1595.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1595.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1595.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44143", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1517.63, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1517.63, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1517.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1517.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1517.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44144", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1567.29, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1567.29, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1567.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1567.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1567.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1537.17, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1537.17, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1537.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1537.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1537.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1905.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1905.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1905.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1905.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1905.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44147", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1670.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1670.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1670.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1670.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1670.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4342.1, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4342.1, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4342.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4342.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4342.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43117", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2388.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2388.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2388.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2388.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2388.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43118", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3218.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3218.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3218.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3218.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3218.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2601.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2601.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2601.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2601.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2601.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2423.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2423.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2423.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2423.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2423.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43123", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3873.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3873.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3873.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3873.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3873.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF EYE FLUID", "code_information": [{"code": "67005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12422.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF EYE FLUID", "code_information": [{"code": "67010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FIBULA", "code_information": [{"code": "27641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FOOT BONE", "code_information": [{"code": "28122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15139.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FOOT BONE", "code_information": [{"code": "28288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HAND BONE", "code_information": [{"code": "26230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1274.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1274.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1274.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1274.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1274.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33031", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1409.48, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1409.48, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1409.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1409.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1409.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HYMEN", "code_information": [{"code": "56700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF KIDNEY", "code_information": [{"code": "50240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1363.8, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1363.8, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1363.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1363.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1363.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31367", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2108.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2108.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2108.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2108.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2108.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31368", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2375.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2375.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2375.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2375.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2375.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2004.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2004.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2004.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2004.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2004.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31375", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1883.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1883.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1883.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1883.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1883.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1865.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1865.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1865.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1865.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1865.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2034.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2034.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2034.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2034.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2034.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIP", "code_information": [{"code": "40530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2137.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2137.59, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2137.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2137.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2137.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2845.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2845.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2845.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2845.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2845.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3056.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3056.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3056.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3056.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3056.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LUNG", "code_information": [{"code": "32480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1495.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1495.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1495.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1495.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1495.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF NOSE", "code_information": [{"code": "30150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF OVARY(S)", "code_information": [{"code": "58920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 692.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 692.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 692.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 692.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 692.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1420.46, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1420.46, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1420.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1420.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1420.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1472.07, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1472.07, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1472.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1472.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1472.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2850.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2850.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2850.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2850.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2850.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PENIS", "code_information": [{"code": "54120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 30336.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PHARYNX", "code_information": [{"code": "42890", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RADIUS", "code_information": [{"code": "25151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RADIUS", "code_information": [{"code": "25230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 998.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 998.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 998.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 998.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 998.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45114", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1633.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1633.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1633.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1633.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1633.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1480.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1480.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1480.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1480.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1480.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF SCAPULA", "code_information": [{"code": "23190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF STERNUM", "code_information": [{"code": "21620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 521.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 521.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 521.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 521.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 521.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF THYROID", "code_information": [{"code": "60220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 36785.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 731.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 731.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 731.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 731.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 731.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF THYROID", "code_information": [{"code": "60225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 879.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 879.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 879.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 879.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 879.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TIBIA", "code_information": [{"code": "27640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "6900137", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10253.0, "discounted_cash": 7689.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "6900137", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 10253.0, "discounted_cash": 7689.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28124", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17512.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 216.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 216.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 216.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 216.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 216.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28153", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10930.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TONGUE", "code_information": [{"code": "41120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 10608.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TONGUE", "code_information": [{"code": "41130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1296.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1296.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1296.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1296.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1296.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25119", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF VULVA", "code_information": [{"code": "56620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 27082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL TEAR GLAND", "code_information": [{"code": "68505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL THYROID EXCISION", "code_information": [{"code": "60210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 33800.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 667.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 667.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 667.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 667.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 667.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL THYROID EXCISION", "code_information": [{"code": "60212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 952.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 952.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 952.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 952.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 952.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTICLE AGGLUT AB EA", "code_information": [{"code": "86403", "type": "CPT"}, {"code": "4106005", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.98, "gross_charge": 61.0, "discounted_cash": 45.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTICLE AGGLUT AB EA/6", "code_information": [{"code": "86403", "type": "CPT"}, {"code": "4106403", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.98, "gross_charge": 324.0, "discounted_cash": 243.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 51.98, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTICLE AGGLUT TITER EA", "code_information": [{"code": "86406", "type": "CPT"}, {"code": "4103999", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.28, "gross_charge": 204.0, "discounted_cash": 153.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 54.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.87, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARVOVIRUS AB", "code_information": [{"code": "86747", "type": "CPT"}, {"code": "7256248", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.65, "gross_charge": 86.0, "discounted_cash": 64.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.65, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARVOVIRUS AB/3", "code_information": [{"code": "86747", "type": "CPT"}, {"code": "7256748", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.65, "gross_charge": 116.0, "discounted_cash": 87.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATCH, LIDOCAINE/TETRACAINE", "code_information": [{"code": "C9285", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PATELA ANY X3 MCK PFJ STRY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 299.46, "maximum": 299.46, "gross_charge": 1426.0, "discounted_cash": 1069.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 299.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA KNEE POLY DJO CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 753.27, "maximum": 753.27, "gross_charge": 3587.0, "discounted_cash": 2690.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 753.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA TM METAL STRYKER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 299.46, "maximum": 299.46, "gross_charge": 1426.0, "discounted_cash": 1069.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 299.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ HIGH 41-60", "code_information": [{"code": "80505", "type": "CPT"}], "standard_charges": [{"minimum": 152.32, "maximum": 152.32, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", 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"standard_charges": [{"minimum": 459.86, "maximum": 459.86, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 459.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 459.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED BLUNT HD TRAUM", "code_information": [{"code": "G0047", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE AGE 2-5 INIT", "code_information": [{"code": "99475", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE AGE 2-5 SUBSQ", "code_information": [{"code": "99476", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRITICAL CARE INITIAL", "code_information": [{"code": "99471", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRITICAL CARE SUBSQ", "code_information": [{"code": "99472", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED FBRL KD IFI27&MCEMP1 RNA", "code_information": [{"code": "389U", "type": "CPT"}], "standard_charges": [{"minimum": 70.2, "maximum": 70.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 70.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 70.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOSPITAL BED SEMI/ELECT", "code_information": [{"code": "E0329", "type": "HCPCS"}], "standard_charges": [{"minimum": 9721.6, "maximum": 11117.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10007.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9721.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11117.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11117.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11117.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOSPITAL BED, MANUAL", "code_information": [{"code": "E0328", "type": "HCPCS"}], "standard_charges": [{"minimum": 8565.14, "maximum": 9794.89, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8816.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8565.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9794.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9794.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9794.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED SIZE BRIEF/DIAPER LG", "code_information": [{"code": "T4530", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED SIZE BRIEF/DIAPER SM/MED", "code_information": [{"code": "T4529", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED SIZE PULL-ON LG", "code_information": [{"code": "T4532", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED SIZE PULL-ON SM/MED", "code_information": [{"code": "T4531", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED VSCLTS KD ALYS 3 BMRKS", "code_information": [{"code": "310U", "type": "CPT"}], "standard_charges": [{"minimum": 390.75, "maximum": 390.75, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED WHL GEN MTHYLTN ALYS 50+", "code_information": [{"code": "318U", "type": "CPT"}], "standard_charges": [{"minimum": 1770.48, "maximum": 1770.48, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1770.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1770.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEDCLE FH/CH/CH/M/N/AX/G/H/F", "code_information": [{"code": "15574", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PEDICLE E/N/E/L/NTRORAL", "code_information": [{"code": "15576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PEG INTERFERON ALFA-2A/180", "code_information": [{"code": "S0145", "type": "HCPCS"}], "standard_charges": [{"minimum": 1142.37, "maximum": 1269.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1142.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1269.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1269.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1269.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1269.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG INTERFERON ALFA-2B/10", "code_information": [{"code": "S0148", "type": "HCPCS"}], "standard_charges": [{"minimum": 154.34, "maximum": 171.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 154.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 171.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 171.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 171.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 171.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG LOCKING IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8134001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 213.36, "maximum": 213.36, "gross_charge": 1016.0, "discounted_cash": 762.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 213.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGADEMASE BOVINE, 25 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2504", "type": "HCPCS"}], "standard_charges": [{"minimum": 331.16, "maximum": 367.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 331.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 367.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 367.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 367.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 367.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGASPARGASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9266", "type": "HCPCS"}], "standard_charges": [{"minimum": 25581.65, "maximum": 28424.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25581.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 28424.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28424.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28424.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28424.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGFILGRASTIM PER 0.5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2506", "type": "HCPCS"}, {"code": "5323112", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 80.41, "maximum": 89.34, "gross_charge": 966.0, "discounted_cash": 724.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 80.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGFILGRASTIM PER 0.5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2506", "type": "HCPCS"}, {"code": "5323112", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 80.41, "maximum": 89.34, "gross_charge": 966.0, "discounted_cash": 724.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 80.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 89.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGFILGRASTIM-JMDB PER 0.5MGIJ", "code_information": [{"code": "Q5108", "type": "HCPCS"}, {"code": "5323097", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 89.22, "maximum": 99.13, "gross_charge": 1383.0, "discounted_cash": 1037.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 89.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 99.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 99.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 99.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 99.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGFILGRASTIM-JMDB PER 0.5MGIJ", "code_information": [{"code": "Q5108", "type": "HCPCS"}, {"code": "5323097", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 89.22, "maximum": 99.13, "gross_charge": 1383.0, "discounted_cash": 1037.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 89.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 99.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 99.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 99.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 99.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGINESATIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0890", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.38, "maximum": 8.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGLOTICASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2507", "type": "HCPCS"}], "standard_charges": [{"minimum": 3294.75, "maximum": 3660.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3294.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3660.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3660.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3660.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3660.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGUNIGALSIDASE ALFA-IWXJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2508", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.34, "maximum": 228.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 205.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 228.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 228.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 228.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 228.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC", "code_information": [{"code": "734", "type": "MS-DRG"}], "standard_charges": [{"minimum": 70720.26, "maximum": 89117.07, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 70720.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 89117.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC", "code_information": [{"code": "735", "type": "MS-DRG"}], "standard_charges": [{"minimum": 44673.29, "maximum": 56294.37, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44673.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 56294.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC EXAMINATION", "code_information": [{"code": "57410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC EXENTERATION", "code_information": [{"code": "45126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2652.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2652.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2652.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2652.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2652.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FRACTURE UNI/BIL", "code_information": [{"code": "G0413", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FX TREAT INT FIX", "code_information": [{"code": "G0414", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIS 1 VIEW", "code_information": [{"code": "72170", "type": "CPT"}, {"code": "4902170", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 209.16, "gross_charge": 996.0, "discounted_cash": 747.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 209.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIS 1 VIEW", "code_information": [{"code": "72170", "type": "CPT"}, {"code": "5012170", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 209.16, "gross_charge": 996.0, "discounted_cash": 747.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 209.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIS 2 VIEWS", "code_information": [{"code": "72170", "type": "CPT"}, {"code": "4902175", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 209.16, "gross_charge": 996.0, "discounted_cash": 747.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 209.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIS 2 VIEWS", "code_information": [{"code": "72170", "type": "CPT"}, {"code": "5012175", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 209.16, "gross_charge": 996.0, "discounted_cash": 747.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 209.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIS MIN 3 VWS", "code_information": [{"code": "72190", "type": "CPT"}, {"code": "4902190", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 226.59, "gross_charge": 1079.0, "discounted_cash": 809.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 91.59, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIS MIN 3 VWS", "code_information": [{"code": "72190", "type": "CPT"}, {"code": "5012190", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 226.59, "gross_charge": 1079.0, "discounted_cash": 809.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 226.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 91.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIS/HIP JT I&D ABSC", "code_information": [{"code": "5066993", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5346.0, "discounted_cash": 4009.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PEMBROLIZUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9271", "type": "HCPCS"}, {"code": "5323115", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 54.26, "maximum": 60.29, "gross_charge": 398.0, "discounted_cash": 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"plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G BE/PR PER 100KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0558", "type": "HCPCS"}, {"code": "5323135", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 17.57, "maximum": 19.52, "gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G BE/PR PER 100KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0558", "type": "HCPCS"}, {"code": "5323135", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 17.57, "maximum": 19.52, "gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G BENZ PER 100KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0561", "type": "HCPCS"}, {"code": "5323121", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 27.01, "maximum": 30.01, "gross_charge": 112.0, "discounted_cash": 84.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G BENZ PER 100KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0561", "type": "HCPCS"}, {"code": "5323121", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 27.01, "maximum": 30.01, "gross_charge": 112.0, "discounted_cash": 84.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G PROC UPTO 600KU IJ", "drug_information": 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1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315991", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PENICILLNVK250/5 200MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315992", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PENICILLNVK250/5 200MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315992", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PENILE ART/VEN FLOW COMP", "code_information": [{"code": "93980", "type": "CPT"}, {"code": "5066851", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 153.23, "maximum": 200.72, "gross_charge": 1565.0, "discounted_cash": 1173.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 200.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 157.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 153.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 200.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 200.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 200.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 200.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE INJECTION", "code_information": [{"code": "54235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 43.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 43.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 43.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 43.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 43.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93981", "type": "CPT"}], "standard_charges": [{"minimum": 153.23, "maximum": 175.23, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 156.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 157.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 153.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 156.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 156.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 156.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 156.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VENOUS OCCLUSION", "code_information": [{"code": "37790", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS PLASTIC SURGERY", "code_information": [{"code": "54360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITH CC/MCC", "code_information": [{"code": "709", "type": "MS-DRG"}], "standard_charges": [{"minimum": 77264.37, "maximum": 97363.54, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 77264.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 97363.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "710", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8940.27, "maximum": 93296.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83965.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45529.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27789.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19208.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 88351.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 47907.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29240.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20211.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93296.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30877.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21343.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50588.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50588.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30877.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21343.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93296.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93296.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50588.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30877.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21343.05, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 23259.32, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8940.27, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 57368.82, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13776.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46522.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 58624.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENTAMIDINE 300MG PW IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2545", "type": "HCPCS"}, {"code": "5331740", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 62.76, "maximum": 69.73, "gross_charge": 583.0, "discounted_cash": 437.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 62.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 69.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 69.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 69.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 69.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTAMIDINE PER 300MG IJ", "code_information": [{"code": "S0080", "type": "HCPCS"}, {"code": "5323189", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 71.4, "maximum": 111.38, "gross_charge": 340.0, "discounted_cash": 255.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 100.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 111.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 111.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 111.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 111.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTASTARCH 10% SOLUTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2513", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.45, "maximum": 12.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTOSTATIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9268", "type": "HCPCS"}], "standard_charges": [{"minimum": 2347.34, "maximum": 2608.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2347.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2608.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2608.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2608.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2608.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTOXIFYLLN 400MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309066", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PENTOXIFYLLN 400MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309066", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PER COR REVAS D-E W/AMI", "code_information": [{"code": "C9606", "type": "HCPCS"}, {"code": "4619606", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52319.35, "gross_charge": 55073.0, "discounted_cash": 41304.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 11565.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 52319.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21610.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20993.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24007.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24007.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24007.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "standard_charge_dollar": 13768.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "standard_charge_dollar": 19275.55, "methodology": "fee schedule"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "standard_charge_dollar": 16521.9, "methodology": "fee schedule"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "standard_charge_dollar": 27536.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "standard_charge_dollar": 13768.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 52319.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20321.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 41304.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 41304.75, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 35797.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PER COR REVAS D-E W/AMI", "code_information": [{"code": "C9606", "type": "HCPCS"}, {"code": "4619606", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52319.35, "gross_charge": 55073.0, "discounted_cash": 41304.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 11565.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 52319.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21610.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20993.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24007.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24007.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24007.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "standard_charge_dollar": 13768.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "standard_charge_dollar": 19275.55, "methodology": "fee schedule"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "standard_charge_dollar": 16521.9, "methodology": "fee schedule"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "standard_charge_dollar": 27536.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "standard_charge_dollar": 13768.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 52319.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20321.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 41304.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 41304.75, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 35797.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC ASP VRT DISC FOR DX", "code_information": [{"code": "5052997", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3905.0, "discounted_cash": 2928.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC AUG 1 BD LUMB/IMG", "code_information": [{"code": "4919720", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12291.0, "discounted_cash": 9218.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC AUG 1 BD THOR/IMG", "code_information": [{"code": "4919718", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6795.0, "discounted_cash": 5096.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC AUG ADD T/L IMG", "code_information": [{"code": "4919719", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5886.0, "discounted_cash": 4414.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC BILIARY BRUSH BIOPS", "code_information": [{"code": "4914306", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13261.0, "discounted_cash": 9945.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC BIOPSY LYMPH NODE", "code_information": [{"code": "4918500", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2594.0, "discounted_cash": 1945.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC BIOPSY LYMPH NODE", "code_information": [{"code": "5057516", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2594.0, "discounted_cash": 1945.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC BIOPSY LYMPH NODE", "code_information": [{"code": "5068505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2594.0, "discounted_cash": 1945.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS MR", "code_information": [{"code": "C7502", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS STERO", "code_information": [{"code": "C7501", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC CATH PORTAL VEIN", "code_information": [{"code": "4910163", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12021.0, "discounted_cash": 9015.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC CHOLECYSTOSTOMY", "code_information": [{"code": "4917600", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7871.0, "discounted_cash": 5903.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC CHOLECYSTOSTOMY", "code_information": [{"code": "5057490", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7871.0, "discounted_cash": 5903.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC CLS INTRATRL W IMPL", "code_information": [{"code": "93580", "type": "CPT"}, {"code": "4613579", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55781.15, "gross_charge": 58717.0, "discounted_cash": 44037.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 12330.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 55781.15, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1037.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21527.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", 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"No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5603.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5603.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5603.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO ADD", "code_information": [{"code": "C9608", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 25570.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO SIN", "code_information": [{"code": "C9607", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 25570.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21527.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20912.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23915.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23915.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23915.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC T CABG B", "code_information": [{"code": "C9605", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 25570.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER BR", "code_information": [{"code": "C9603", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 25570.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER S", "code_information": [{"code": "C9602", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 25570.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21527.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20912.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23915.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23915.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23915.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC DEVC BRST 1ST MAMMO", "code_information": [{"code": "3079281", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3398.0, "discounted_cash": 2548.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DEVC BRST 1ST MAMMO", "code_information": [{"code": "5019281", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3398.0, "discounted_cash": 2548.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DEVC BRST 1ST MR", "code_information": [{"code": "5259287", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6656.0, "discounted_cash": 4992.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DEVC BRST 1ST STRTC", "code_information": [{"code": "3079283", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5102.0, "discounted_cash": 3826.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DEVC BRST 1ST STRTC", "code_information": [{"code": "5019283", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1366.0, "discounted_cash": 1024.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DEVC BRST 1ST US", "code_information": [{"code": "5019285", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1041.0, "discounted_cash": 780.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DEVC BRST 1ST US", "code_information": [{"code": "5069285", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1135.0, "discounted_cash": 851.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DEVC BRST ADD MAM", "code_information": [{"code": "3079282", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2208.0, "discounted_cash": 1656.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DEVC BRST ADD MAM", "code_information": [{"code": "5019282", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2208.0, "discounted_cash": 1656.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DEVC BRST ADD MR", "code_information": [{"code": "5259288", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7887.0, "discounted_cash": 5915.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DEVC BRST ADD STRTC", "code_information": [{"code": "5019284", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2040.0, "discounted_cash": 1530.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DEVC BRST ADD US", "code_information": [{"code": "5019286", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2026.0, "discounted_cash": 1519.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DEVC BRST ADD US", "code_information": [{"code": "5069286", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 667.0, "discounted_cash": 500.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DISC REMOVAL W/IMAG", "code_information": [{"code": "4912283", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 24020.0, "discounted_cash": 18015.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC DRAIN W CATH PLC", "code_information": [{"code": "75989", "type": "CPT"}, {"code": "4915990", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1066.38, "gross_charge": 5078.0, "discounted_cash": 3808.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1066.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 372.57, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC DRAIN W CATH PLC", "code_information": [{"code": "75989", "type": "CPT"}, {"code": "5055990", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1066.38, "gross_charge": 5078.0, "discounted_cash": 3808.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1066.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 372.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC DRAIN W CATH PLC", "code_information": [{"code": "75989", "type": "CPT"}, {"code": "5067630", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1066.38, "gross_charge": 5078.0, "discounted_cash": 3808.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1066.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 372.57, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 180.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-EL COR STENT BRAN", "code_information": [{"code": "C9601", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 25570.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC INSERT IABP DEV", "code_information": [{"code": "4613967", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3190.0, "discounted_cash": 2392.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC MECH THROMBECTMY VN", "code_information": [{"code": "4617187", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 24293.0, "discounted_cash": 18219.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC MECH THROMBECTMY VN", "code_information": [{"code": "4914104", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 15250.0, "discounted_cash": 11437.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC NEPH/PYELO 0-2CM", "code_information": [{"code": "4915008", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 32223.0, "discounted_cash": 24167.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC PERICRD DRNG INSRT CATH<5", "code_information": [{"code": "4613021", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2919.0, "discounted_cash": 2189.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC PERICRD DRNG INSRT CATH>6", "code_information": [{"code": "4613019", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1943.0, "discounted_cash": 1457.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC RF ABLATE BONE TUMR", "code_information": [{"code": "4912098", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9980.0, "discounted_cash": 7485.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC RF ABLATE LIVR TUMR", "code_information": [{"code": "4917382", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 18954.0, "discounted_cash": 14215.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC RF ABLATE LIVR TUMR", "code_information": [{"code": "5057382", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17902.0, "discounted_cash": 13426.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC RF ABLATE PULM TUMR+IMG", "code_information": [{"code": "5052998", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 33758.0, "discounted_cash": 25318.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC RF ABLATE RENAL TUMOR", "code_information": [{"code": "50592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC RF ABLATE RENL TUMR", "code_information": [{"code": "5050592", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6279.0, "discounted_cash": 4709.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC RF ABLATE RENL TUMR", "code_information": [{"code": "5060592", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13724.0, "discounted_cash": 10293.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC SACRL AUGMENT BILAT", "code_information": [{"code": "4912288", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6795.0, "discounted_cash": 5096.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC SACRL AUGMENT UNIL", "code_information": [{"code": "4912286", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19223.0, "discounted_cash": 14417.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC SACRL AUGMENT UNIL", "code_information": [{"code": "5052899", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19223.0, "discounted_cash": 14417.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC TRNSHEP PORT W/EVL", "code_information": [{"code": "75885", "type": "CPT"}, {"code": "4915886", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 2861.66, "gross_charge": 9555.0, "discounted_cash": 7166.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2006.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1345.98, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC TRSHEP PORT WO/EVL", "code_information": [{"code": "75887", "type": "CPT"}, {"code": "4915888", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 2861.66, "gross_charge": 9201.0, "discounted_cash": 6900.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1932.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1352.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 450.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 450.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 450.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 450.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 450.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC VALVULOPLSTY AORTIC", "code_information": [{"code": "92986", "type": "CPT"}, {"code": "4610500", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 57634.6, "gross_charge": 60668.0, "discounted_cash": 45501.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 12740.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 57634.6, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1445.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6559.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6372.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7286.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7286.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7286.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1445.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 57634.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1445.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1445.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1445.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22386.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 45501.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 45501.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC VERT 1 BD ADD/IMG", "code_information": [{"code": "4914480", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8018.0, "discounted_cash": 6013.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERCUT ABLATE LIVER RF", "code_information": [{"code": "47382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1921.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUT ALLERGY SKIN TESTS", "code_information": [{"code": "95004", "type": "CPT"}], "standard_charges": [{"minimum": 6.62, "maximum": 68.55, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 61.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 68.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 68.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 68.55, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [{"code": "273", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 172606.79, "estimated_discounted_cash": 233334.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 136974.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 172606.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [{"code": "274", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 137721.44, "estimated_discounted_cash": 163447.98, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 109291.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137721.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES", "code_information": [{"code": "321", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 113835.55, "estimated_discounted_cash": 182666.16, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 85891.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 39910.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 54938.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32902.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 90377.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 57807.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 41995.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34620.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 95436.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36558.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 61043.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 44345.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36558.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 95436.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 44345.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 61043.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 61043.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 44345.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 95436.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36558.49, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 20380.12, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 31908.67, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 47343.14, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 23475.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 90336.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 113835.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [{"code": "322", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 73762.16, "estimated_discounted_cash": 153954.45, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 48620.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 65099.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37025.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 34099.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 68499.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51159.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 38959.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 35880.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 72333.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 54022.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 41139.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 37889.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 54022.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 41139.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 37889.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 72333.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 72333.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 54022.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 41139.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 37889.09, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 25370.13, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 29462.59, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 49135.63, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 27942.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 58535.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 73762.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [{"code": "250", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 91313.62, "estimated_discounted_cash": 121333.64, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 72463.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 91313.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [{"code": "251", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 62528.39, "estimated_discounted_cash": 69783.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11304.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8753.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14922.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25219.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9210.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11894.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26536.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15701.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16580.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9726.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12560.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28021.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12560.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9726.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16580.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28021.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16580.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9726.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12560.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28021.7, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6224.14, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5274.41, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9370.78, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 14454.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49620.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 62528.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS ISLET CELLTRANS", "code_information": [{"code": "G0341", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERF ULTRSND TO LCT PREG DOC", "code_information": [{"code": "G8806", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERFLUTREN LIP MICRO 1ML", "code_information": [{"code": "Q9957", "type": "HCPCS"}, {"code": "5358247", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"minimum": 80.85, "maximum": 80.85, "gross_charge": 385.0, "discounted_cash": 288.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 80.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERFLUTREN LIP MICRO 1ML", "code_information": [{"code": "Q9957", "type": "HCPCS"}, {"code": "5358247", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 80.85, "maximum": 80.85, "gross_charge": 385.0, "discounted_cash": 288.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 80.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERI MEDICAMENT W/SEAL, MAND", "code_information": [{"code": "D5996", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERI MEDICAMENT W/SEAL, MAX", "code_information": [{"code": "D5995", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERI-IMPLT CAPSLC BRST COMPL", "code_information": [{"code": "19371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIACETABULAR OSTEOTOMY", "code_information": [{"code": "S2115", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERICARDIOCENTESIS W/IMAGING", "code_information": [{"code": "33016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERICARDIOCENTESIS W/IMG GUIDE", "code_information": [{"code": "4613016", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7090.0, "discounted_cash": 5317.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERIODIC ORAL EVALUATION", "code_information": [{"code": "D0120", "type": "HCPCS"}], "standard_charges": [{"minimum": 29.58, "maximum": 33.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [{"code": "300", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35443.13, "maximum": 44663.13, "estimated_discounted_cash": 47884.46, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35443.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44663.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [{"code": "299", "type": "MS-DRG"}], "standard_charges": [{"minimum": 54208.91, "maximum": 68310.54, "estimated_discounted_cash": 106983.12, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 54208.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 68310.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "301", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23895.48, "maximum": 30111.53, "estimated_discounted_cash": 35908.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23895.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30111.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [{"code": "41", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8139.26, "maximum": 91991.41, "estimated_discounted_cash": 115344.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 28907.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19539.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13270.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14791.33, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13964.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20559.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30417.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15563.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21710.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16434.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14745.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32120.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21710.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16434.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14745.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32120.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16434.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14745.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21710.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32120.3, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8139.26, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 14065.96, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 22685.31, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9578.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 73001.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 91991.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC", "code_information": [{"code": "40", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11588.57, "maximum": 161548.75, "estimated_discounted_cash": 192448.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16477.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52170.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32181.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 23174.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33862.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 24384.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 54895.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17337.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57967.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 25749.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18308.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 35757.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18308.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 25749.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 35757.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", 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"plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 41348.6, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 17376.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 128199.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 161548.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "42", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12357.82, "maximum": 72285.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21103.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE 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{"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [{"code": "336", "type": "MS-DRG"}], "standard_charges": [{"minimum": 70013.06, "maximum": 88225.9, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 70013.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"discounted_cash": 3066.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 858.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ABLTJ LVR CRYOABLATION", "code_information": [{"code": "47383", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for 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"No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ ART M-THROMBECT &/NFS", "code_information": [{"code": "61645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ CERVICOTHORACIC INJECT", "code_information": [{"code": "22510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ CLSR TCAT L ATR APNDGE", "code_information": [{"code": "33340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ CVT&LS INJ VERT BODIES", "code_information": [{"code": "C7504", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST MR GUIDE", "code_information": [{"code": "19287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST STRTCTC", "code_information": [{"code": "19283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST US IMAG", "code_information": [{"code": "19285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 998.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD MR GUIDE", "code_information": [{"code": "19288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD STRTCTC", "code_information": [{"code": "19284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD US IMAG", "code_information": [{"code": "19286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST 1ST IMAG", "code_information": [{"code": "19281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2478.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST EA IMAG", "code_information": [{"code": "19282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1558.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ IMPLTJ/RPLCMT ISDNS PTN", "code_information": [{"code": "587T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ ISLET CELL TRANSPLANT", "code_information": [{"code": "584T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ LAMOT/LAM CRV/THRC", "code_information": [{"code": "274T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ LAMOT/LAM LUMBAR", "code_information": [{"code": "275T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "estimated_discounted_cash": 22157.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ LS&CVT INJ VERT BODIES", "code_information": [{"code": "C7505", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ LUMB&THOR VERT AUG", "code_information": [{"code": "C7508", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ LUMBOSACRAL INJECTION", "code_information": [{"code": "22511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 53114.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR 1ST", "code_information": [{"code": "629T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR EA", "code_information": [{"code": "630T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC FLUOR LMBR 1ST", "code_information": [{"code": "627T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC FLUOR LMBR EA", "code_information": [{"code": "628T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NL/PL LITHOTRP CPLX>2CM", "code_information": [{"code": "50081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 24307.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1324.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21875.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24307.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1324.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1324.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1324.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1324.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NL/PL LITHOTRP SMPL<2CM", "code_information": [{"code": "50080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 24307.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 905.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21875.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24307.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 905.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 905.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 905.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 905.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR BI", "code_information": [{"code": "33903", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR UNI", "code_information": [{"code": "33902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT BI", "code_information": [{"code": "33901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT UNI", "code_information": [{"code": "33900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC EACH ADDL", "code_information": [{"code": "33904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47538", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47539", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ PRCRD DRG INSJ CATH CT", "code_information": [{"code": "33019", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT BILAT INJ", "code_information": [{"code": "201T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 33590.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT UNILAT INJ", "code_information": [{"code": "200T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ STENT/CHEST VERT ART", "code_information": [{"code": "75T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT ILIAC ANAST IMPLT", "code_information": [{"code": "553T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT INTRATRL SEPTL SHT", "code_information": [{"code": "613T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT US ABLTJ NRV P-ART", "code_information": [{"code": "632T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ THOR&LUMB VERT AUG", "code_information": [{"code": "C7507", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE EACH", "code_information": [{"code": "93592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE PDA", "code_information": [{"code": "93582", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 23915.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21527.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20912.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23915.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23915.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23915.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS AORTIC", "code_information": [{"code": "93591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS MITRAL", "code_information": [{"code": "93590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH SEPTAL REDUXN", "code_information": [{"code": "93583", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1544.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1500.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1715.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1715.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1715.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSLUM CORONARY LITHOTR", "code_information": [{"code": "92972", "type": "CPT"}, {"code": "4610715", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 4200.0, "maximum": 21668.0, "gross_charge": 20246.0, "discounted_cash": 15184.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4251.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 19233.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 19233.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7470.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 15184.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 15184.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRLUML ANGP NT/RECR COA", "code_information": [{"code": "33897", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TX MALAR FRACTURE", "code_information": [{"code": "21355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TX NASOETHMOID FX", "code_information": [{"code": "21340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [{"code": "22513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 31838.0, "estimated_discounted_cash": 40098.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 31838.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [{"code": "22514", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 31838.0, "estimated_discounted_cash": 29459.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 31838.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [{"code": "22515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 31838.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 31838.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ&IC ALLG TEST DRUGS/BIOL", "code_information": [{"code": "95018", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONAL CARE ITEM NOS EACH", "code_information": [{"code": "S5199", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERTUSSIS AG IF", "code_information": [{"code": "87265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERTUZU, TRASTUZU, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9316", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.89, "maximum": 62.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 55.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 62.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 62.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 62.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 62.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERTUZUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9306", "type": "HCPCS"}, {"code": "5323232", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 15.32, "maximum": 17.02, "gross_charge": 84.0, "discounted_cash": 63.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERTUZUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9306", "type": "HCPCS"}, {"code": "5323232", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 15.32, "maximum": 17.02, "gross_charge": 84.0, "discounted_cash": 63.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE 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"standard_charge_dollar": 2364.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2364.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2364.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2364.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE LTD AREA", "code_information": [{"code": "78811", "type": "CPT"}], "standard_charges": [{"minimum": 1305.94, "maximum": 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"standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PH BODY FLUID NOS/2", "code_information": [{"code": "83986", "type": "CPT"}, {"code": "7259358", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.25, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 18.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE 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"80186", "type": "CPT"}, {"code": "7254045", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 70.19, "gross_charge": 162.0, "discounted_cash": 121.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 70.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENYTOIN TOTAL", "code_information": [{"code": "80185", "type": "CPT"}, {"code": "4102655", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.6, "gross_charge": 347.0, "discounted_cash": 260.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.6, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHLEB VEINS - EXTREM 20+", "code_information": [{"code": "37766", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHLEBOTOMY THERAPEUTIC", "code_information": [{"code": "99195", "type": "CPT"}, {"code": "4549195", "type": "CDM"}, {"code": "940", "type": "RC"}], "standard_charges": [{"minimum": 69.64, "maximum": 7835.0, "gross_charge": 839.0, "discounted_cash": 629.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHLEBOTOMY/THERAPEUT", "code_information": [{"code": "99195", "type": "CPT"}, {"code": "6922730", "type": "CDM"}, {"code": "940", "type": "RC"}], "standard_charges": [{"minimum": 69.64, "maximum": 7835.0, "gross_charge": 556.0, "discounted_cash": 417.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHLEBOTOMY/THERAPEUTIC", "code_information": [{"code": "99195", "type": "CPT"}, {"code": "4209013", "type": "CDM"}, {"code": "940", "type": "RC"}], "standard_charges": [{"minimum": 69.64, "maximum": 7835.0, "gross_charge": 556.0, "discounted_cash": 417.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 69.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHONE E/M PHYS/QHP 11-20 MIN", "code_information": [{"code": "99442", "type": "CPT"}], "standard_charges": [{"minimum": 24.11, "maximum": 24.11, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHONE E/M PHYS/QHP 21-30 MIN", "code_information": [{"code": "99443", "type": "CPT"}], "standard_charges": [{"minimum": 35.71, "maximum": 35.71, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHONE E/M PHYS/QHP 5-10 MIN", "code_information": [{"code": "99441", "type": "CPT"}], "standard_charges": [{"minimum": 13.28, "maximum": 13.28, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOSPHATASE ACID TOTAL", "code_information": [{"code": "84060", "type": "CPT"}, {"code": "7254060", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.67, "gross_charge": 71.0, "discounted_cash": 53.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 37.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOSPHATASE ALKALINE", "code_information": [{"code": "84075", "type": "CPT"}, {"code": "4104075", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 226.0, "discounted_cash": 169.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOSPHATASE ALKALINE", "code_information": [{"code": "84075", "type": "CPT"}, {"code": "7254075", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 226.0, "discounted_cash": 169.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOSPHATASE ALKALINE/2", "code_information": [{"code": "84075", "type": "CPT"}, {"code": "7254076", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 116.0, "discounted_cash": 87.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOSPHATASE ISO ALK", "code_information": [{"code": "84080", "type": "CPT"}, {"code": "7254080", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 75.41, "gross_charge": 167.0, "discounted_cash": 125.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": 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[{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 52.63, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"discounted_cash": 71.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 91.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOSPHORUS", "code_information": [{"code": "84100", "type": "CPT"}, {"code": "4104100", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.2, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 24.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOSPHORUS URINE", "code_information": [{"code": "84105", "type": "CPT"}, {"code": "4104102", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.39, "gross_charge": 124.0, "discounted_cash": 93.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTO PATCH TEST", "code_information": [{"code": "95052", "type": "CPT"}], "standard_charges": [{"minimum": 9.51, "maximum": 9.51, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.51, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY UV-A OR B", "code_information": [{"code": "96913", "type": "CPT"}], "standard_charges": [{"minimum": 121.29, "maximum": 489.19, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE 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"HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 121.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 121.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 121.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY WITH UV-A", "code_information": [{"code": "96912", "type": "CPT"}], "standard_charges": [{"minimum": 76.13, "maximum": 89.87, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY WITH UV-B", "code_information": [{"code": "96910", "type": "CPT"}], "standard_charges": [{"minimum": 70.24, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 70.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS 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"outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTODYNMC TX 30 MIN ADD-ON", "code_information": [{"code": "96570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 58.35, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 58.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 58.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 58.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 58.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTOPHERESIS", "code_information": [{"code": "36522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTOREFRACTIVE KERATECTOMY", "code_information": [{"code": "S0810", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOSENSITIVITY TESTS", "code_information": [{"code": "95056", "type": "CPT"}], "standard_charges": [{"minimum": 32.98, "maximum": 32.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOTHERAP KERATECT", "code_information": [{"code": "S0812", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHP/IOP OT SERVICE", "code_information": [{"code": "G0129", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV AUTHRJ", "code_information": [{"code": "86079", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 174.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV XMATCH", "code_information": [{"code": "86077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 172.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 172.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS EXAM FOR COLLEGE", "code_information": [{"code": "S0622", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHYS REVIEW OF MOTION TESTS", "code_information": [{"code": "96004", "type": "CPT"}], "standard_charges": [{"minimum": 112.73, "maximum": 261.19, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 112.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 235.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 228.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 261.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 261.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 261.19, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 112.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 112.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 112.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 112.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICAL PERFORMANCE TEST", "code_information": [{"code": "97750", "type": "CPT"}], "standard_charges": [{"minimum": 24.19, "maximum": 81.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 73.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 71.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 81.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 81.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 81.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICIAN STANDBY SERVICES", "code_information": [{"code": "99360", "type": "CPT"}], "standard_charges": [{"minimum": 55.36, "maximum": 55.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 55.36, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 55.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 55.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 55.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 55.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYTONADIONE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309461", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 123.0, "discounted_cash": 92.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PHYTONADIONE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309461", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 123.0, "discounted_cash": 92.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIERCE EARLOBES", "code_information": [{"code": "69090", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 800.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 800.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 800.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 800.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 800.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61253", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 886.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 886.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 886.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 886.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 886.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & REMOVE CLOT", "code_information": [{"code": "61154", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1171.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1171.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1171.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1171.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1171.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR BIOPSY", "code_information": [{"code": "61140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1174.53, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1174.53, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1174.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1174.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1174.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1256.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1256.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1256.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1256.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1256.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 922.29, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 922.29, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 922.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 922.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 922.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61156", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1170.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1170.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1170.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1170.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1170.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL IMPLANT DEVICE", "code_information": [{"code": "61210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 360.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 360.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 360.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 360.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 360.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIFLU F-18, DIA 1 MILLICURIE", "code_information": [{"code": "A9595", "type": "HCPCS"}], "standard_charges": [{"minimum": 788.34, "maximum": 875.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 788.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 875.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 875.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 875.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 875.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIK3CA GENE TRGT SEQ ALYS", "code_information": [{"code": "81309", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILD/PLACEBO CONTROL CLIN TR", "code_information": [{"code": "G0276", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309470", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PILOCARPINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309470", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BUTTRESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 144.06, "maximum": 144.06, "gross_charge": 686.0, "discounted_cash": 514.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 144.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN CERCLAGE POSITION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 222.18, "maximum": 222.18, "gross_charge": 1058.0, "discounted_cash": 793.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 222.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN DISTRACTION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.98, "maximum": 112.98, "gross_charge": 538.0, "discounted_cash": 403.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 112.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN FINGER DISLOCATION", "code_information": [{"code": "26776", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIN FINGER FRACTURE EACH", "code_information": [{"code": "26756", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIN HAND DISLOCATION", "code_information": [{"code": "26676", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIN HOFMAN TRNFX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 898.38, "maximum": 898.38, "gross_charge": 4278.0, "discounted_cash": 3208.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 898.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN KNUCKLE DISLOCATION", "code_information": [{"code": "26706", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIN RADIOULNAR DISLOCATION", "code_information": [{"code": "25671", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIN STEINMAN PL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 956.76, "maximum": 956.76, "gross_charge": 4556.0, "discounted_cash": 3417.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 956.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN TRANSFIX SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3679.83, "maximum": 3679.83, "gross_charge": 17523.0, "discounted_cash": 13142.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3679.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN TYPE I", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.24, "maximum": 429.24, "gross_charge": 2044.0, "discounted_cash": 1533.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 429.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN TYPE II", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 189.63, "maximum": 189.63, "gross_charge": 903.0, "discounted_cash": 677.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 189.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN TYPE III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 566.37, "maximum": 566.37, "gross_charge": 2697.0, "discounted_cash": 2022.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 566.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN TYPE IV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133639", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 209.37, "maximum": 209.37, "gross_charge": 997.0, "discounted_cash": 747.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 209.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN ULNAR STYLOID FRACTURE", "code_information": [{"code": "25651", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PINCH GRAFT UP TO 2 CM DIAM", "code_information": [{"code": "15050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PINCH GRAFT UP TO 2CM", "code_information": [{"code": "6909889", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PINCH GRAFT UP TO 2CM", "code_information": [{"code": "6909889", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PINWORM EXAM", "code_information": [{"code": "87172", "type": "CPT"}, {"code": "4107144", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.75, "gross_charge": 124.0, "discounted_cash": 93.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINWORM EXAM", "code_information": [{"code": "87172", "type": "CPT"}, {"code": "7257172", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.75, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINWORM EXAMINATIONS", "code_information": [{"code": "Q0113", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.27, "maximum": 4.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIOGLITAZONE 15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309500", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIOGLITAZONE 15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309500", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PITUITARY EVALUATION PANEL", "code_information": [{"code": "80418", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2948.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2948.47, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 809.76, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 809.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 809.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 809.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 809.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 579.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 579.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PJP PROPH ORDERED CD4 LOW", "code_information": [{"code": "G9223", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PKNG NASAL MEROGEL", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "8240277", "type": "CDM"}], "standard_charges": [{"minimum": 13.44, "maximum": 13.44, "gross_charge": 64.0, "discounted_cash": 48.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PL GASTRO TUBE W/FLUORO", "code_information": [{"code": "4919440", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4877.0, "discounted_cash": 3657.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PL JEJUNOSTMYTBE WFLUORO", "code_information": [{"code": "4919442", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11316.0, "discounted_cash": 8487.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PL STNT BIL W/O DRN", "code_information": [{"code": "4917539", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 35982.0, "discounted_cash": 26986.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PL STNT INT/EXT BILE DRN", "code_information": [{"code": "4917540", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 35982.0, "discounted_cash": 26986.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLACE BREAST CATH FOR RAD", "code_information": [{"code": "19297", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE BREAST RAD TUBE/CATHS", "code_information": [{"code": "19298", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTD ART", "code_information": [{"code": "36224", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36223", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH INTRACRANIAL ART", "code_information": [{"code": "36228", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH SUBCLAVIAN ART", "code_information": [{"code": "36225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH THORACIC AORTA", "code_information": [{"code": "36221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH VERTEBRAL ART", "code_information": [{"code": "36226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH XTRNL CAROTID", "code_information": [{"code": "36227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN AORTA", "code_information": [{"code": "36200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 805.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 805.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 805.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 805.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 805.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1017.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1017.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1017.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1017.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1017.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36014", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1008.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1008.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1008.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1008.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1008.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1098.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1098.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1098.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1098.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1098.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1387.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1387.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1387.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1387.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1387.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1504.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1504.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1504.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1504.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1504.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36217", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2561.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2561.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2561.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2561.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2561.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36218", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 240.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 240.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 240.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 240.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 240.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 789.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 789.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 789.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 789.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 789.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1207.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1207.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1207.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1207.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1207.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1029.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1029.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1029.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1029.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1029.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CECOSTOMY TUBE PERC", "code_information": [{"code": "49442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1269.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1269.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1269.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1269.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1269.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE DEVICE/MARKER, NON PRO", "code_information": [{"code": "C9728", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1859.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2064.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2064.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2064.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2064.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE ENDORECTAL APP", "code_information": [{"code": "C9725", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 635.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 635.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 635.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 635.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 635.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 534.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 534.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 534.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 534.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 534.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 969.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 969.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 969.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 969.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 969.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE PERC", "code_information": [{"code": "49440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE NDL MUSC/TIS FOR RT", "code_information": [{"code": "20555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLE IN VEIN", "code_information": [{"code": "36000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES H&N FOR RT", "code_information": [{"code": "41019", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES PELVIC FOR RT", "code_information": [{"code": "55920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE PERM PACING CARDIOVERT", "code_information": [{"code": "G0448", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE PO BREAST CATH FOR RAD", "code_information": [{"code": "19296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE RT DEVICE/MARKER PROS", "code_information": [{"code": "55876", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 76.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 76.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 76.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 76.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 76.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACEMENT BILE DUCT SUPPORT", "code_information": [{"code": "47801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1012.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1012.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1012.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1012.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1012.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF DRAIN PANCREAS", "code_information": [{"code": "48001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2104.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2104.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2104.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2104.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2104.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF SETON", "code_information": [{"code": "46020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACENTAL A1 MICRO DIR", "code_information": [{"code": "84112", "type": "CPT"}, {"code": "4103507", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 328.97, "gross_charge": 1502.0, "discounted_cash": 1126.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 328.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 98.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 98.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACENTAL A1 MICRO DIR/2", "code_information": [{"code": "84112", "type": "CPT"}, {"code": "4104112", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 328.97, "gross_charge": 1502.0, "discounted_cash": 1126.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 328.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 98.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 98.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMA VOLUME MULTIPLE", "code_information": [{"code": "78111", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 1305.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMA VOLUME SINGLE", "code_information": [{"code": "78110", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 1305.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 159.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 81.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 81.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 81.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 81.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 81.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMAPHERESIS THERAPTC", "code_information": [{"code": "4502260", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12308.0, "discounted_cash": 9231.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASTIC SURGERY NECK", "code_information": [{"code": "15819", "type": "CPT"}], "standard_charges": [{"minimum": 903.02, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATE OTHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 655.41, "maximum": 655.41, "gross_charge": 3121.0, "discounted_cash": 2340.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 655.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET AB", "code_information": [{"code": "86022", "type": "CPT"}, {"code": "4106022", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.66, "gross_charge": 1441.0, "discounted_cash": 1080.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 93.66, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET AB", "code_information": [{"code": "86022", "type": "CPT"}, {"code": "7256014", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.66, "gross_charge": 724.0, "discounted_cash": 543.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 93.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET AB/2", "code_information": [{"code": "86022", "type": "CPT"}, {"code": "7256017", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.66, "gross_charge": 724.0, "discounted_cash": 543.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 93.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET AB/6", "code_information": [{"code": "86022", "type": "CPT"}, {"code": "7256027", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.66, "gross_charge": 106.0, "discounted_cash": 79.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 93.66, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET AUTO", "code_information": [{"code": "85049", "type": "CPT"}, {"code": "4105595", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 22.81, "gross_charge": 166.0, "discounted_cash": 124.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.25, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET DEPLETE OF HARVEST", "code_information": [{"code": "38213", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan 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CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 25.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 25.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLETHSYMOGRAPHY LUNG VOL", "code_information": [{"code": "94726", "type": "CPT"}, {"code": "5504726", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 343.64, "maximum": 392.98, "gross_charge": 1014.0, "discounted_cash": 760.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLEURAL DRAINAGE PERC", "code_information": [{"code": "4912557", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3972.0, "discounted_cash": 2979.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLEURAL DRAINAGE PERC", "code_information": [{"code": "5052557", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3972.0, "discounted_cash": 2979.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLEURAL DRAINAGE PERC", "code_information": [{"code": "5062557", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3972.0, "discounted_cash": 2979.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH CC", "code_information": [{"code": "187", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32840.1, "maximum": 41382.95, "estimated_discounted_cash": 42515.54, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32840.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41382.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH MCC", "code_information": [{"code": "186", "type": "MS-DRG"}], "standard_charges": [{"minimum": 51745.32, "maximum": 65206.08, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 51745.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 65206.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITHOUT CC/MCC", "code_information": [{"code": "188", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23812.47, "maximum": 30006.93, "estimated_discounted_cash": 19519.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23812.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30006.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLICAMYCIN (MITHRAMYCIN) INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9270", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.08, "maximum": 78.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 71.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 78.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 78.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 78.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 78.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT ACCESS BIL TREE SM BWL", "code_information": [{"code": "47541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47533", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 7221.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47534", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROSTOMY CATHETER", "code_information": [{"code": "50432", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "estimated_discounted_cash": 15890.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROURETERAL CATHETER", "code_information": [{"code": "50433", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT ADDL", "code_information": [{"code": "222T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT CERV", "code_information": [{"code": "219T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT LUMB", "code_information": [{"code": "221T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT THOR", "code_information": [{"code": "220T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV 1ST", "code_information": [{"code": "10035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 11647.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV EA", "code_information": [{"code": "10036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50693", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50694", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50695", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT XTN PROSTH EVASC RPR", "code_information": [{"code": "34709", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLNNING PT SPEC FENEST GRAFT", "code_information": [{"code": "34839", "type": "CPT"}], "standard_charges": [{"minimum": 12252.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLT AGGREGATION EA AGENT", "code_information": [{"code": "85576", "type": "CPT"}, {"code": "4105576", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 109.54, "gross_charge": 1371.0, "discounted_cash": 1028.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 109.54, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT AGGREGATION EA AGENT", "code_information": [{"code": "85576", "type": "CPT"}, {"code": "7035577", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 109.54, "gross_charge": 1371.0, "discounted_cash": 1028.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 109.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT AGGREGATION EA AGENT/2", "code_information": [{"code": "85576", "type": "CPT"}, {"code": "4105577", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 109.54, "gross_charge": 504.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 109.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT BN MED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133675", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 321.51, "maximum": 321.51, "gross_charge": 1531.0, "discounted_cash": 1148.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 321.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT BN SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 830.13, "maximum": 830.13, "gross_charge": 3953.0, "discounted_cash": 2964.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 830.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT CABLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11733.96, "maximum": 11733.96, "gross_charge": 55876.0, "discounted_cash": 41907.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 11733.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT CALCANEAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 688.8, "maximum": 688.8, "gross_charge": 3280.0, "discounted_cash": 2460.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 688.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT CLAW FT/ANKL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133688", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3316.74, "maximum": 3316.74, "gross_charge": 15794.0, "discounted_cash": 11845.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3316.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT COMP LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3250.38, "maximum": 3250.38, "gross_charge": 15478.0, "discounted_cash": 11608.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3250.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2914.8, "maximum": 2914.8, "gross_charge": 13880.0, "discounted_cash": 10410.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2914.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT CONDYLAR TIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8130231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 390.81, "maximum": 390.81, "gross_charge": 1861.0, "discounted_cash": 1395.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 390.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT CROSSLINK TIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 602.49, "maximum": 602.49, "gross_charge": 2869.0, "discounted_cash": 2151.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 602.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT DECOMPRESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2410.17, "maximum": 2410.17, "gross_charge": 11477.0, "discounted_cash": 8607.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2410.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT DISTAL LATERAL FEMUR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3006.78, "maximum": 3006.78, "gross_charge": 14318.0, "discounted_cash": 10738.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3006.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT DISTL FIBULA LCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1272.81, "maximum": 1272.81, "gross_charge": 6061.0, "discounted_cash": 4545.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1272.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT E 1/3 TUBE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133825", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 528.36, "maximum": 528.36, "gross_charge": 2516.0, "discounted_cash": 1887.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 528.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT E COMP BRD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 607.53, "maximum": 607.53, "gross_charge": 2893.0, "discounted_cash": 2169.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 607.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT E COMP DCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 685.23, "maximum": 685.23, "gross_charge": 3263.0, "discounted_cash": 2447.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 685.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT E COMP DHS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 897.96, "maximum": 897.96, "gross_charge": 4276.0, "discounted_cash": 3207.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 897.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT E COMP NRW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 571.83, "maximum": 571.83, "gross_charge": 2723.0, "discounted_cash": 2042.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 571.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT E CONDYLR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 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"standard_charge_dollar": 18051.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18051.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12086.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29649.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9322.77, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4242.49, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16367.24, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": 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of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 63.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 63.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 63.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 63.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 63.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": 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"methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35860.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLYCARB LENS", "code_information": [{"code": "S0580", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POLYETHYLE GLYCOL 17GMPW", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316072", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "POLYETHYLE GLYCOL 17GMPW", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316072", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "POLYSOM <6 YRS CPAP/BILVL", "code_information": [{"code": "95783", "type": "CPT"}], "standard_charges": [{"minimum": 1243.2, "maximum": 1421.7, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1243.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYSOM ANY AGE 1-3> PARAM", "code_information": [{"code": "95808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2209.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2209.25, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 773.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1243.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 773.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 773.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 773.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 773.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYSOMNGRPHY W/CPAP", "code_information": [{"code": "95811", "type": "CPT"}, {"code": "4806999", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 3072.11, "gross_charge": 19719.0, "discounted_cash": 14789.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3072.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1042.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1243.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1042.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1042.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1042.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1042.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYSOMNOGRAPHY", "code_information": [{"code": "95810", "type": "CPT"}, {"code": "6912105", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2788.89, "gross_charge": 13057.0, "discounted_cash": 9792.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2788.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS 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{"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 947.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 947.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 947.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYSOMNOGRAPHY 4 >", "code_information": [{"code": "95810", "type": "CPT"}, {"code": "4805828", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2788.89, "gross_charge": 17619.0, "discounted_cash": 13214.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2788.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee 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"standard_charge_dollar": 947.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 947.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 947.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 947.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYSOMNOGRAPHY <6 YRS", "code_information": [{"code": "95782", "type": "CPT"}, {"code": "4805782", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1243.2, "maximum": 1421.7, "gross_charge": 36490.0, "discounted_cash": 27367.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1243.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYSOMNOGRAPHY CPAP 4", "code_information": [{"code": "95811", "type": "CPT"}, {"code": "6912102", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 3072.11, "gross_charge": 12526.0, "discounted_cash": 9394.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US 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"plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1042.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1042.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1042.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1042.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYSTYRENE 15GM PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316064", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 35.25, 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14.25, "setting": "both", "billing_class": "facility"}]}, {"description": "POLYVALENT MULT ORG EA AG IA", "code_information": [{"code": "87451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 48.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 43.07, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PORPHYRINS", "code_information": [{"code": "84311", "type": "CPT"}, {"code": "7254321", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.66, "gross_charge": 229.0, "discounted_cash": 171.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 35.66, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PORPHYRINS FECES QN", "code_information": [{"code": "84126", "type": "CPT"}, {"code": "7254125", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 129.9, "gross_charge": 541.0, "discounted_cash": 405.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 129.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.59, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": 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{"description": "PORT FILM", "code_information": [{"code": "77417", "type": "CPT"}, {"code": "5107416", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.68, "gross_charge": 408.0, "discounted_cash": 306.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 85.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 71.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.29, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"code_information": [{"code": "S8096", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POS AIRWAY PRESS PRESCRIBED", "code_information": [{"code": "G8845", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POS CLIN DEPRES SCRN F/U DOC", "code_information": [{"code": "G8431", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSACONAZOLE 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316082", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 291.75, "setting": "both", "billing_class": "facility"}]}, {"description": "POSACONAZOLE 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316082", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 291.75, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONAL CHANGE OF FINGER", "code_information": [{"code": "26555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSITIONAL NYSTAGMUS TEST", "code_information": [{"code": "92542", "type": "CPT"}], "standard_charges": [{"minimum": 68.32, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 68.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 68.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 68.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 68.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 68.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST D/C H VST NEW PT 20 M", "code_information": [{"code": "G2001", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST GLENOID SHLD ARTHROSRF CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 664.23, "maximum": 664.23, "gross_charge": 3163.0, "discounted_cash": 2372.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 664.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST OP SERVICE LVRS MIN 6", "code_information": [{"code": "G0305", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST TAPER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8134003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.42, "maximum": 840.42, "gross_charge": 4002.0, "discounted_cash": 3001.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 840.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST VERT ARTHRPLST 1 LUMBAR", "code_information": [{"code": "202T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POST-COITAL MUCOUS EXAM", "code_information": [{"code": "Q0115", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.0, "maximum": 25.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C CARE PLAN OVERS 30M", "code_information": [{"code": "G2014", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C CARE PLAN OVERS 60M", "code_information": [{"code": "G2015", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 20 M", "code_information": [{"code": "G2006", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 30 M", "code_information": [{"code": "G2007", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 45 M", "code_information": [{"code": "G2008", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 60 M", "code_information": [{"code": "G2009", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST EXT PT 75 M", "code_information": [{"code": "G2013", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST NEW PT 30 M", "code_information": [{"code": "G2002", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST NEW PT 45 M", "code_information": [{"code": "G2003", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST NEW PT 60 M", "code_information": [{"code": "G2004", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST-D/C H VST NEW PT 75 M", "code_information": [{"code": "G2005", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSTERIOR GAIT TRAINER", "code_information": [{"code": "E8000", "type": "HCPCS"}], "standard_charges": [{"minimum": 1650.24, "maximum": 1887.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1698.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1650.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1887.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1887.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1887.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTOP FOLLOW-UP VISIT", "code_information": [{"code": "99024", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTOP REN FAIL", "code_information": [{"code": "G8575", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC", "code_information": [{"code": "862", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4883.04, "maximum": 76301.78, "estimated_discounted_cash": 62367.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15087.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14368.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8824.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12859.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15875.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15118.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13531.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9285.76, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15965.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9805.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14288.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16763.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14288.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16763.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9805.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15965.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14288.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16763.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15965.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9805.46, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8347.99, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7951.4, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7115.17, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4883.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 60550.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 76301.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC", "code_information": [{"code": "863", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13447.59, "maximum": 139042.72, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 41196.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 80292.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16194.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 125137.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 84486.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 131673.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43348.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17040.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 139042.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 45774.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17994.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 89214.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17994.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE 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NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PPPS, SUBSEQ VISIT", "code_information": [{"code": "G0439", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRALATREXATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9307", "type": "HCPCS"}], "standard_charges": [{"minimum": 353.37, "maximum": 392.63, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 392.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRAMIPEXOLE .25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309692", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRAMIPEXOLE .25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309692", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRAMIPEXOLE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309694", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRAMIPEXOLE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309694", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRASUGREL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309703", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRASUGREL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309703", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRAZOSIN 1MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309723", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRAZOSIN 1MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309723", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRAZOSIN 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309731", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRAZOSIN 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309731", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRCRD DRG 0-5YR OR W/ANOMLY", "code_information": [{"code": "33018", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRCRD DRG 6YR+ W/O CGEN CAR", "code_information": [{"code": "33017", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRE-ALBUMIN", "code_information": [{"code": "84134", "type": "CPT"}, {"code": "4104176", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.39, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.38, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-HTN OR HTN DOC, F/U INDC", "code_information": [{"code": "G8950", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-HTN/HTN, NO F/U, NOT GVN", "code_information": [{"code": "G8952", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-OP SERVICE LVRS 1-9 DOS", "code_information": [{"code": "G0304", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-OP SERVICE LVRS 10-15DOS", "code_information": [{"code": "G0303", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-OP SERVICE LVRS COMPLETE", "code_information": [{"code": "G0302", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREDNISOLONE 15/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316123", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PREDNISOLONE 15/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316123", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PREDNISOLONE ACETATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2650", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.47, "maximum": 0.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREFAB PORC/CERAM CROWN PRI", "code_information": [{"code": "D2929", "type": "HCPCS"}], "standard_charges": [{"minimum": 176.21, "maximum": 201.51, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 181.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 176.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 201.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 201.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 201.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREFABRICATED RESIN CROWN", "code_information": [{"code": "D2932", "type": "HCPCS"}], "standard_charges": [{"minimum": 197.68, "maximum": 226.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 203.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 197.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 226.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 226.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 226.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREG ASSOC PLSM PROTN A", "code_information": [{"code": "84163", "type": "CPT"}, {"code": "7254163", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.76, "gross_charge": 327.0, "discounted_cash": 245.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.76, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREGABALIN", "code_information": [{"code": "80366", "type": "CPT"}, {"code": "7258030", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 1397.0, "discounted_cash": 1047.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee 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"both", "billing_class": "facility"}]}, {"description": "PREGABALIN 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309796", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PREGNENOLONE", "code_information": [{"code": "84140", "type": "CPT"}, {"code": "7254140", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 105.45, "gross_charge": 119.0, "discounted_cash": 89.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 105.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.89, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [{"code": "791", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30.0, "maximum": 5978.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4743.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5978.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [{"code": "792", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30.0, "maximum": 101166.44, "estimated_discounted_cash": 229167.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25736.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 48502.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 91048.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32554.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34254.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 95804.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51036.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 27080.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36171.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 101166.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 53892.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28596.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 53892.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36171.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 101166.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28596.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 53892.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36171.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 101166.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28596.23, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 21482.49, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 72525.4, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 35423.21, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 15892.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2377.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2996.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PRENATAL AT RISK EDUCATION", "code_information": [{"code": "H1003", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRENATAL VITAMINS 30 DAY", "code_information": [{"code": "S0197", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP & CANNULJ CDVR DON LUNG", "code_information": [{"code": "494T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP CADAVER RENAL ALLOGRAFT", "code_information": [{"code": "50323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP CORNEAL ENDO ALLOGRAFT", "code_information": [{"code": "65757", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/ARTERY", "code_information": [{"code": "44721", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 364.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 364.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 364.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 364.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 364.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/VENOUS", "code_information": [{"code": "44720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 250.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 250.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 250.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 250.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 250.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER 3-SEGMENT", "code_information": [{"code": "47144", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER LOBE SPLIT", "code_information": [{"code": "47145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER WHOLE", "code_information": [{"code": "47143", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/ARTERIAL", "code_information": [{"code": "47147", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/VENOUS", "code_information": [{"code": "47146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 312.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 312.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 312.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 312.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 312.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS", "code_information": [{"code": "48551", "type": "CPT"}], "standard_charges": [{"minimum": 7835.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS/VENOUS", "code_information": [{"code": "48552", "type": "CPT"}], "standard_charges": [{"minimum": 215.94, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 215.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 215.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 215.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 215.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 215.94, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR RENAL GRAFT", "code_information": [{"code": "50325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/ARTERIAL", "code_information": [{"code": "50328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 177.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 177.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 177.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 177.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 177.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/URETERAL", "code_information": [{"code": "50329", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 171.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 171.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 171.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 171.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 171.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/VENOUS", "code_information": [{"code": "50327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 201.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 201.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 201.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 201.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 201.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP TUM CAV IORT PRIM CRNOT", "code_information": [{"code": "735T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARATION FOR BLADDER XRAY", "code_information": [{"code": "51605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARATION OF REPORT", "code_information": [{"code": "90889", "type": "CPT"}], "standard_charges": [{"minimum": 26.79, "maximum": 26.79, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.79, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARATION PALATE MOLD", "code_information": [{"code": "42280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 77.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 77.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 77.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 77.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 77.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART", "code_information": [{"code": "33944", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART/LUNG", "code_information": [{"code": "33933", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR INTESTINE", "code_information": [{"code": "44715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG DOUBLE", "code_information": [{"code": "32856", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG SINGLE", "code_information": [{"code": "32855", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE EMBRYO FOR TRANSFER", "code_information": [{"code": "89255", "type": "CPT"}], "standard_charges": [{"minimum": 49.76, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 374.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 374.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 374.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 374.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 374.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 914.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 914.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 914.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 914.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 914.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21079", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 651.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 651.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 651.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 651.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 651.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 746.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 746.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 746.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 746.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 746.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 685.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 685.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 685.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 685.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 685.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21082", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 629.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 629.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 629.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 629.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 629.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21083", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 618.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 618.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 618.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 618.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 618.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21084", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 721.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 721.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 721.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 721.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 721.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 279.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 279.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 279.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 279.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 279.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 673.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 673.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 673.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 673.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 673.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21087", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 667.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 667.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 667.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 667.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 667.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21088", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FECAL MICROBIOTA", "code_information": [{"code": "44705", "type": "CPT"}], "standard_charges": [{"minimum": 4200.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE HEART-AORTA CONDUIT", "code_information": [{"code": "33404", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1808.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1808.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1808.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1808.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1808.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE PENIS STUDY", "code_information": [{"code": "54230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 105.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 105.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 105.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 105.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 105.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE SPERM DUCT X-RAY", "code_information": [{"code": "55300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 197.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 197.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 197.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 197.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 197.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPJ TUM CAV IORT PRTL MAST", "code_information": [{"code": "19294", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPUTIAL STRETCHING", "code_information": [{"code": "54450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRES ANTIBX ON/WITHIN 3 DAY", "code_information": [{"code": "G8711", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRESBYOPIA FUNCTION IOL", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "8122173", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 5104.0, "discounted_cash": 3828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PRESCRIPTION DRUG, GENERIC", "code_information": [{"code": "S5000", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRESCRIPTION DRUG,BRAND NAME", "code_information": [{"code": "S5001", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRESSURE TREATMENT ESOPHAGUS", "code_information": [{"code": "43460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 213.26, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 213.26, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 213.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 213.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 213.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRETX RBC AB W/CHEM EA", "code_information": [{"code": "86970", "type": "CPT"}, {"code": "7146213", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 33.84, "maximum": 33.84, "gross_charge": 385.0, "discounted_cash": 288.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRETX RBC AB W/DENSITY", "code_information": [{"code": "86972", "type": "CPT"}, {"code": "4106972", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "gross_charge": 415.0, "discounted_cash": 311.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRETX RBC AB W/DENSITY", "code_information": [{"code": "86972", "type": "CPT"}, {"code": "7149604", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "gross_charge": 121.0, "discounted_cash": 90.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRETX RBC AB W/DRUG EA", "code_information": [{"code": "86975", "type": "CPT"}, {"code": "7140012", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 270.22, "maximum": 270.22, "gross_charge": 618.0, "discounted_cash": 463.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 270.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 270.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRETX RBC AB W/ENZYM EA", "code_information": [{"code": "86971", "type": "CPT"}, {"code": "7146026", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 291.26, "maximum": 291.26, "gross_charge": 417.0, "discounted_cash": 312.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRETX RBC EA ABSRP", "code_information": [{"code": "86978", "type": "CPT"}, {"code": "7146012", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 33.84, "maximum": 33.84, "gross_charge": 335.0, "discounted_cash": 251.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRETX RBC S W/INHIB EA", "code_information": [{"code": "86977", "type": "CPT"}, {"code": "7140014", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "gross_charge": 582.0, "discounted_cash": 436.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRETX RBC W/DILUTION", "code_information": [{"code": "86976", "type": "CPT"}, {"code": "7140013", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.67, "maximum": 24.67, "gross_charge": 162.0, "discounted_cash": 121.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL IIMS IP", "code_information": [{"code": "528T", "type": "CPT"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL IMPLTBL SYS", "code_information": [{"code": "93260", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL PM/LDLS PM", "code_information": [{"code": "93279", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL SCRMS IP", "code_information": [{"code": "93285", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL WCS IP", "code_information": [{"code": "522T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL CARDIAC MODULJ", "code_information": [{"code": "417T", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93282", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93283", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93284", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVL LDLS PM 1CHMBR IP", "code_information": [{"code": "826T", "type": "CPT"}], "standard_charges": [{"minimum": 46.15, "maximum": 52.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 47.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 46.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVL LDLS PM 2CHMBR IP", "code_information": [{"code": "804T", "type": "CPT"}], "standard_charges": [{"minimum": 53.51, "maximum": 61.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 55.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 53.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 61.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 61.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 61.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG IO RTA ELTRD RA", "code_information": [{"code": "472T", "type": "CPT"}], "standard_charges": [{"minimum": 381.91, "maximum": 436.74, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 393.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 381.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 436.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 436.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 436.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC 1ST VSL", "code_information": [{"code": "37184", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC SBSQ VSL", "code_information": [{"code": "37185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIMAQUINE 26.3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309809", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIMAQUINE 26.3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309809", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIMATRIX", "code_information": [{"code": "Q4110", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRIMIDONE", "code_information": [{"code": "80188", "type": "CPT"}, {"code": "7250188", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 84.61, "gross_charge": 196.0, "discounted_cash": 147.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 84.61, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMIDONE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309824", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIMIDONE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309824", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIMIDONE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309820", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIMIDONE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309820", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE OBSTETRICS", "code_information": [{"code": "1990043", "type": "CDM"}, {"code": "112", "type": "RC"}], "standard_charges": [{"gross_charge": 4263.0, "discounted_cash": 3197.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE OBSTETRICS", "code_information": [{"code": "2500043", "type": "CDM"}, {"code": "112", "type": "RC"}], "standard_charges": [{"gross_charge": 4263.0, "discounted_cash": 3197.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE PSYCHIATRIC", "code_information": [{"code": "1990052", "type": "CDM"}, {"code": "114", "type": "RC"}], "standard_charges": [{"gross_charge": 7929.0, "discounted_cash": 5946.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE PSYCHIATRIC", "code_information": [{"code": "2120052", "type": "CDM"}, {"code": "114", "type": "RC"}], "standard_charges": [{"gross_charge": 7929.0, "discounted_cash": 5946.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE PSYCHIATRIC", "code_information": [{"code": "2430052", "type": "CDM"}, {"code": "114", "type": "RC"}], "standard_charges": [{"gross_charge": 7929.0, "discounted_cash": 5946.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE PSYCHIATRIC", "code_information": [{"code": "2440052", "type": "CDM"}, {"code": "114", "type": "RC"}], "standard_charges": [{"gross_charge": 7929.0, "discounted_cash": 5946.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE PSYCHIATRIC", "code_information": [{"code": "2460052", "type": "CDM"}, {"code": "114", "type": "RC"}], "standard_charges": [{"gross_charge": 7929.0, "discounted_cash": 5946.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE PSYCHIATRIC", "code_information": [{"code": "2470052", "type": "CDM"}, {"code": "114", "type": "RC"}], "standard_charges": [{"gross_charge": 7929.0, "discounted_cash": 5946.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE PSYCHIATRIC", "code_information": [{"code": "2490052", "type": "CDM"}, {"code": "114", "type": "RC"}], "standard_charges": [{"gross_charge": 7929.0, "discounted_cash": 5946.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "1990001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 4263.0, "discounted_cash": 3197.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2120001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 4263.0, "discounted_cash": 3197.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2150001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 4263.0, "discounted_cash": 3197.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2160001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 4263.0, "discounted_cash": 3197.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2310001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 4263.0, "discounted_cash": 3197.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2350001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 4263.0, "discounted_cash": 3197.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2500001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 4263.0, "discounted_cash": 3197.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PRO-INSULIN", "code_information": [{"code": "84206", "type": "CPT"}, {"code": "7253526", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.85, "gross_charge": 314.0, "discounted_cash": 235.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 90.85, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68811", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROBE NL DUCT W/BALLOON", "code_information": [{"code": "68816", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 468.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 468.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 468.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 468.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 468.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROBE, PERC LUMB DISC", "code_information": [{"code": "C2614", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROBE/NEEDLE, CRYO", "code_information": [{"code": "C2618", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROBENECID 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309847", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBENECID 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309847", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCAINAMIDE UPTO 1GM IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2690", "type": "HCPCS"}, {"code": "5323678", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 265.22, "maximum": 294.69, "gross_charge": 350.0, "discounted_cash": 262.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 265.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 294.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 294.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 294.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 294.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCAINAMIDE UPTO 1GM IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2690", "type": "HCPCS"}, {"code": "5323678", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 265.22, "maximum": 294.69, "gross_charge": 350.0, "discounted_cash": 262.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 265.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 294.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 294.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 294.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 294.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCALCITONIN", "code_information": [{"code": "84145", "type": "CPT"}, {"code": "4108374", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 101.32, "gross_charge": 185.0, "discounted_cash": 138.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 101.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCALCITONIN", "code_information": [{"code": "84145", "type": "CPT"}, {"code": "7258374", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 101.32, "gross_charge": 305.0, "discounted_cash": 228.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 101.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCARBAZINE, ORAL", "code_information": [{"code": "S0182", "type": "HCPCS"}], "standard_charges": [{"minimum": 152.38, "maximum": 169.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 152.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 169.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 169.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 169.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 169.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309983", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309983", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 5 MG", "code_information": [{"code": "S0183", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.35, "maximum": 0.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309979", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309979", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE MALEATE 5MG", "code_information": [{"code": "Q0164", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY ABLATE", "code_information": [{"code": "45320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY BLEED", "code_information": [{"code": "45317", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY DILATE", "code_information": [{"code": "45303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY DX", "code_information": [{"code": "45300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 63.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 63.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 63.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 63.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 63.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY FB", "code_information": [{"code": "45307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17320.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY REMOVAL", "code_information": [{"code": "45308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY REMOVAL", "code_information": [{"code": "45309", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY REMOVAL", "code_information": [{"code": "45315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY VOLVUL", "code_information": [{"code": "45321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 959.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/BX", "code_information": [{"code": "45305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/STENT", "code_information": [{"code": "45327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCURE DONOR SPERM", "code_information": [{"code": "S4026", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROCUREN OR OTHER GROWTH FAC", "code_information": [{"code": "S9055", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROGESTERONE", "code_information": [{"code": "84144", "type": "CPT"}, {"code": "4104144", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 106.4, "gross_charge": 541.0, "discounted_cash": 405.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGESTERONE", "code_information": [{"code": "84144", "type": "CPT"}, {"code": "7254144", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 106.4, "gross_charge": 541.0, "discounted_cash": 405.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGRAM INTAKE ASSESSMENT", "code_information": [{"code": "T1023", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROGRAMMER PT NEUROSTIM", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "8240357", "type": "CDM"}], "standard_charges": [{"minimum": 1177.05, "maximum": 1177.05, "gross_charge": 5605.0, "discounted_cash": 4203.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1177.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROL INTUBATION REQ", "code_information": [{"code": "G8569", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLACTIN", "code_information": [{"code": "84146", "type": "CPT"}, {"code": "4104146", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 98.84, "gross_charge": 811.0, "discounted_cash": 608.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 98.84, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.08, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLACTIN", "code_information": [{"code": "84146", "type": "CPT"}, {"code": "7254146", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 98.84, "gross_charge": 811.0, "discounted_cash": 608.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 98.84, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.08, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG IP/OBS E/M EA 15 MIN", "code_information": [{"code": "99418", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONG HOME EVAL ADD 15M", "code_information": [{"code": "G0318", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONG INPT EVAL ADD15 M", "code_information": [{"code": "G0316", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONG NURSIN FAC EVAL 15M", "code_information": [{"code": "G0317", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLONG SERV W/O CONTACT ADD", "code_information": [{"code": "99359", "type": "CPT"}], "standard_charges": [{"minimum": 47.31, "maximum": 47.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 47.31, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 47.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 47.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 47.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 47.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG SERVICE W/O CONTACT", "code_information": [{"code": "99358", "type": "CPT"}], "standard_charges": [{"minimum": 97.87, "maximum": 97.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 97.87, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 97.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 97.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 97.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 97.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONGED IV INF, REQ PUMP", "code_information": [{"code": "C8957", "type": "HCPCS"}], "standard_charges": [{"minimum": 392.77, "maximum": 449.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 404.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 392.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 449.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZ 6.25MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316155", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROMETHAZ 6.25MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316155", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROMETHAZINE 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310065", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PROMETHAZINE 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310065", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PROMETHAZINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310068", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROMETHAZINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310068", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROMETHAZINE HCL 12.5MG ORAL", "code_information": [{"code": "Q0169", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROPAFENONE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310090", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPAFENONE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310090", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPH RTA DTCHMNT CRTX DTHRM", "code_information": [{"code": "67141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 184.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 184.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 184.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 184.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 184.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROPH RTA DTCHMNT PC", "code_information": [{"code": "67145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 203.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 203.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 203.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 203.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 203.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROPOXYPHENE QNT", "code_information": [{"code": "80367", "type": "CPT"}, {"code": "7253953", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 1397.0, "discounted_cash": 1047.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPRANOLOL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310199", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPRANOLOL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310199", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPRANOLOL 120MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310211", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPRANOLOL 120MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310211", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPRANOLOL 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310201", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPRANOLOL 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310201", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPRANOLOL 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310203", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPRANOLOL 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310203", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPRANOLOL 60MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310208", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPRANOLOL 60MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310208", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPRANOLOL 80MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310210", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPRANOLOL 80MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310210", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPYLTHIOURACIL 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310216", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPYLTHIOURACIL 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310216", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROS ARTICULAR SURFACE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8134150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1581.72, "maximum": 1581.72, "gross_charge": 7532.0, "discounted_cash": 5649.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1581.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROS AUGMENTATION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8134155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1049.37, "maximum": 1049.37, "gross_charge": 4997.0, "discounted_cash": 3747.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1049.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROS BN PLUG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8134260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 85.05, "maximum": 85.05, "gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 85.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROS BRST MENTR SALINE", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "8242871", "type": "CDM"}], "standard_charges": [{"minimum": 575.82, "maximum": 575.82, "gross_charge": 2742.0, "discounted_cash": 2056.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 575.82, 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EACH/2", "code_information": [{"code": "84150", "type": "CPT"}, {"code": "7258415", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 127.31, "gross_charge": 528.0, "discounted_cash": 396.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 127.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 34.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATE BIOPSY, ANY MTHD", "code_information": [{"code": "G0416", "type": "HCPCS"}], "standard_charges": [{"minimum": 291.26, "maximum": 291.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATE CA SCREENING; DRE", "code_information": [{"code": "G0102", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROSTATE LASER ENUCLEATION", "code_information": [{"code": "52649", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1048.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1048.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1048.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1048.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1048.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATE SATURATION SAMPLING", "code_information": [{"code": "55706", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY (TURP)", "code_information": [{"code": "52601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18687.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITH CC", "code_information": [{"code": "666", "type": "MS-DRG"}], "standard_charges": [{"minimum": 58080.26, "maximum": 73188.96, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 58080.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 73188.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITH MCC", "code_information": [{"code": "665", "type": "MS-DRG"}], "standard_charges": [{"minimum": 103630.08, "maximum": 130587.89, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 103630.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 130587.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITHOUT CC/MCC", "code_information": [{"code": "667", "type": "MS-DRG"}], "standard_charges": [{"minimum": 36728.05, "maximum": 46282.3, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 36728.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46282.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATIC MICROWAVE THERMOTX", "code_information": [{"code": "53850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 18785.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16905.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18785.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATIC RF THERMOTX", "code_information": [{"code": "53852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 18785.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16905.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18785.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2020.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTH RETINA RECEIVE&GEN", "code_information": [{"code": "100T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTHETIC TRAING 1ST ENC", "code_information": [{"code": "97761", "type": "CPT"}], "standard_charges": [{"minimum": 23.47, "maximum": 95.84, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 86.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 83.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 95.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 95.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 95.84, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN ANALYSIS W/PROBE", "code_information": [{"code": "88372", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 116.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 116.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN C ACTIVITY/2", "code_information": [{"code": "85303", "type": "CPT"}, {"code": "7255304", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 70.52, "gross_charge": 282.0, "discounted_cash": 211.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 70.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN C ANTIGEN", "code_information": [{"code": "85302", "type": "CPT"}, {"code": "7255302", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.32, "gross_charge": 472.0, "discounted_cash": 354.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN C CONCENTRATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2724", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.54, "maximum": 15.04, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN C RESIST", "code_information": [{"code": "85307", "type": "CPT"}, {"code": "4105307", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 78.15, "gross_charge": 715.0, "discounted_cash": 536.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 78.15, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN C RESIST", "code_information": [{"code": "85307", "type": "CPT"}, {"code": "7255307", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 78.15, "gross_charge": 715.0, "discounted_cash": 536.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 78.15, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN ELCTRO OTHER FLUIDS", "code_information": [{"code": "84166", "type": "CPT"}, {"code": "7254167", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.96, "gross_charge": 384.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 90.96, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN ELCTRO OTHER FLUIDS/2", "code_information": [{"code": "84166", "type": "CPT"}, {"code": "7254168", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.96, "gross_charge": 102.0, "discounted_cash": 76.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 90.96, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN ELCTRO OTHER FLUIDS/3", "code_information": [{"code": "84166", "type": "CPT"}, {"code": "7254169", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.96, "gross_charge": 102.0, "discounted_cash": 76.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 90.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN ELCTRO SERUM", "code_information": [{"code": "84165", "type": "CPT"}, {"code": "7254165", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.79, "gross_charge": 116.0, "discounted_cash": 87.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 54.79, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN S FREE", "code_information": [{"code": "85306", "type": "CPT"}, {"code": "7255311", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 78.15, "gross_charge": 427.0, "discounted_cash": 320.25, "setting": "both", 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{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTOZOA AB NES/4", "code_information": [{"code": "86753", "type": "CPT"}, {"code": "7252149", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.22, "gross_charge": 193.0, "discounted_cash": 144.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTOZOA AB NES/6", "code_information": [{"code": "86753", "type": "CPT"}, {"code": "7256713", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.22, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTOZOA AB NES/7", "code_information": [{"code": "86753", "type": "CPT"}, {"code": "7256718", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.22, "gross_charge": 71.0, "discounted_cash": 53.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROVIDE INR TEST MATER/EQUIP", "code_information": [{"code": "G0249", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.78, "maximum": 180.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 162.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 157.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 180.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRP I/HERN INIT BLOCK >5 YR", "code_information": [{"code": "49507", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 27082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRP I/HERN INIT REDUC >5 YR", "code_information": [{"code": "49505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 28969.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRPERTL PEL PACK HEMRRG TRMA", "code_information": [{"code": "49013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ AV FSTL CRT UXTR SEP ACS", "code_information": [{"code": "36837", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ AV FSTL CRTJ UXTR 1 ACS", "code_information": [{"code": "36836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CARD ANGIO/ATHRECT ADDL", "code_information": [{"code": "92925", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ ELC NRV STIM CN WO IMPLT", "code_information": [{"code": "720T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ NJX BIOD OSTEO MATRL FEM", "code_information": [{"code": "814T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT ADDL", "code_information": [{"code": "92938", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ TCAT THRM ABLT NRV P-ART", "code_information": [{"code": "793T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRTL EXC BONE OLECRN PROCESS", "code_information": [{"code": "24147", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRTL EXC BONE RADIAL H/N", "code_information": [{"code": "24145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRTL EXCHANGE TRANSFUSE NB", "code_information": [{"code": "36456", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRXML EXT THOR AORTA ADD", "code_information": [{"code": "4912406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1987.0, "discounted_cash": 1490.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PSA FREE", "code_information": [{"code": "84154", "type": "CPT"}, {"code": "4108415", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.81, "gross_charge": 223.0, "discounted_cash": 167.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 93.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA FREE", "code_information": [{"code": "84154", "type": "CPT"}, {"code": "7254200", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.81, "gross_charge": 114.0, "discounted_cash": 85.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 93.81, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA SCREENING", "code_information": [{"code": "G0103", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 93.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA TOTAL", "code_information": [{"code": "84153", "type": "CPT"}, {"code": "4106316", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.81, "gross_charge": 512.0, "discounted_cash": 384.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 93.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA TOTAL", "code_information": [{"code": "84153", "type": "CPT"}, {"code": "7256316", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.81, "gross_charge": 512.0, "discounted_cash": 384.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 93.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA TOTAL/2", "code_information": [{"code": "84153", "type": "CPT"}, {"code": "7254153", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.81, "gross_charge": 106.0, "discounted_cash": 79.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 93.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSEUDOANEURYSM INJECTION TRT", "code_information": [{"code": "36002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 106.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 106.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 106.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 106.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 106.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PST VRT JT RPLCMT LMBR 1 SGM", "code_information": [{"code": "719T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSY EVALUATION OF RECORDS", "code_information": [{"code": "90885", "type": "CPT"}], "standard_charges": [{"minimum": 37.28, "maximum": 37.28, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.28, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSY THRPY 30 MIN PT", "code_information": [{"code": "90832", "type": "CPT"}, {"code": "6400832", "type": "CDM"}, {"code": "914", "type": "RC"}], "standard_charges": [{"minimum": 173.72, "maximum": 198.66, "gross_charge": 416.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 178.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 173.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSY THRPY 30 MIN PT", "code_information": [{"code": "90832", "type": "CPT"}, {"code": "6420832", "type": "CDM"}, {"code": "914", "type": "RC"}], "standard_charges": [{"minimum": 173.72, "maximum": 198.66, "gross_charge": 416.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 178.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 173.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSY THRPY 45MIN PT", "code_information": [{"code": "90834", "type": "CPT"}, {"code": "6400834", "type": "CDM"}, {"code": "914", "type": "RC"}], "standard_charges": [{"minimum": 173.72, "maximum": 198.66, "gross_charge": 511.0, "discounted_cash": 383.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 178.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 173.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSY THRPY 45MIN PT", "code_information": [{"code": "90834", "type": "CPT"}, {"code": "6420834", "type": "CDM"}, {"code": "914", "type": "RC"}], "standard_charges": [{"minimum": 173.72, "maximum": 198.66, "gross_charge": 511.0, "discounted_cash": 383.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 178.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 173.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSY THRPY 60MIN PT", "code_information": [{"code": "90837", "type": "CPT"}, {"code": "6400838", "type": "CDM"}, {"code": "914", "type": "RC"}], "standard_charges": [{"minimum": 173.72, "maximum": 198.66, "gross_charge": 586.0, "discounted_cash": 439.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 178.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 173.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSY THRPY 60MIN PT", "code_information": [{"code": "90837", "type": "CPT"}, {"code": "6420837", "type": "CDM"}, {"code": "914", "type": "RC"}], "standard_charges": [{"minimum": 173.72, "maximum": 198.66, "gross_charge": 586.0, "discounted_cash": 439.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 178.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 173.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC ANXIETY DO MRNA 15 BMRK", "code_information": [{"code": "437U", "type": "CPT"}], "standard_charges": [{"minimum": 760.0, "maximum": 760.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", 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"discounted_cash": 1437.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT CANALITH REPOS PROC CMPLX", "code_information": [{"code": "95992", "type": "CPT"}, {"code": "5705995", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 1916.0, "discounted_cash": 1437.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT CANALITH REPOS PROC EXTNSV", "code_information": [{"code": "95992", "type": "CPT"}, {"code": "5705996", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 1916.0, "discounted_cash": 1437.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT CANALITH REPOS PROC INTERM", "code_information": [{"code": "95992", "type": "CPT"}, {"code": "5705994", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 1916.0, "discounted_cash": 1437.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT CAT AND THCK ON REPORT", "code_information": [{"code": "G9294", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT COMM/WK REINT TRN EA15M", "code_information": [{"code": "97537", "type": "CPT"}, {"code": "5705320", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 374.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT DISCH HOME DAY #2 CEA", "code_information": [{"code": "G8834", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DISCH HOME DAY #2 EVAR", "code_information": [{"code": "G8826", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC NO BURN PRIOR TO D/C", "code_information": [{"code": "G8909", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC NO EVENTS ON DISCHARG", "code_information": [{"code": "G8907", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC NO FALL IN ASC", "code_information": [{"code": "G8911", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC NO WRONG EVENT", "code_information": [{"code": "G8913", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC TO HAVE FALL IN ASC", "code_information": [{"code": "G8910", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC W BURN PRIOR TO D/C", "code_information": [{"code": "G8908", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT DOC WITH WRONG EVENT", "code_information": [{"code": "G8912", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT E-STIM BASIC", "code_information": [{"code": "G0283", "type": "HCPCS"}, {"code": "5700283", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT E-STIM BASIC", "code_information": [{"code": "G0283", "type": "HCPCS"}, {"code": "6057013", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT E-STIM MAN EA 15 BSC", "code_information": [{"code": "97032", "type": "CPT"}, {"code": "6051496", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 372.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT E-STIM MANUAL 15 BSC", "code_information": [{"code": "97032", "type": "CPT"}, {"code": "5705266", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 372.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT ED POS 23", "code_information": [{"code": "G0035", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT EDUCATION NOC GROUP", "code_information": [{"code": "S9446", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT EDUCATION NOC INDIVID", "code_information": [{"code": "S9445", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT EVAL HIGH COMP", "code_information": [{"code": "97163", "type": "CPT"}, {"code": "5705205", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 1351.0, "discounted_cash": 1013.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT EVAL HIGH COMP", "code_information": [{"code": "97163", "type": "CPT"}, {"code": "6051405", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 1351.0, "discounted_cash": 1013.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT EVAL HIGH COMPLEX 45 MIN", "code_information": [{"code": "97163", "type": "CPT"}], "standard_charges": [{"minimum": 171.77, "maximum": 196.43, "estimated_discounted_cash": 1272.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 176.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 171.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 196.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 196.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 196.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT EVAL LOW COMP", "code_information": [{"code": "97161", "type": "CPT"}, {"code": "5705201", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 1351.0, "discounted_cash": 1013.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT EVAL LOW COMP", "code_information": [{"code": "97161", "type": "CPT"}, {"code": "6051401", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 1351.0, "discounted_cash": 1013.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT EVAL LOW COMPLEX 20 MIN", "code_information": [{"code": "97161", "type": "CPT"}], "standard_charges": [{"minimum": 171.77, "maximum": 196.43, "estimated_discounted_cash": 1264.01, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 176.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 171.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 196.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 196.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 196.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT EVAL LOW COMPLX 20M-TELEMED", "code_information": [{"code": "97161", "type": "CPT"}, {"code": "5707161", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 565.0, "discounted_cash": 423.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT EVAL LOW COMPLX 20M-TELEMED", "code_information": [{"code": "97161", "type": "CPT"}, {"code": "6057161", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 565.0, "discounted_cash": 423.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT EVAL MOD COMP", "code_information": [{"code": "97162", "type": "CPT"}, {"code": "5705203", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 1351.0, "discounted_cash": 1013.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT EVAL MOD COMP", "code_information": [{"code": "97162", "type": "CPT"}, {"code": "6051403", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 1351.0, "discounted_cash": 1013.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT EVAL MOD COMPLEX 30 MIN", "code_information": [{"code": "97162", "type": "CPT"}], "standard_charges": [{"minimum": 171.77, "maximum": 196.43, "estimated_discounted_cash": 1181.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 176.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 171.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 196.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 196.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 196.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT EVAL MOD COMPLX 30M-TELEMED", "code_information": [{"code": "97162", "type": "CPT"}, {"code": "5707162", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 565.0, "discounted_cash": 423.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT EVAL MOD COMPLX 30M-TELEMED", "code_information": [{"code": "97162", "type": "CPT"}, {"code": "6057162", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 565.0, "discounted_cash": 423.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT GAIT/STAIR TRN 15M-TELEMED", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "5707117", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 112.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT GAIT/STAIR TRN 15M-TELEMED", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "6057117", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 112.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT GAIT/STR TRN EA 15", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "5705656", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT GAIT/STR TRN EA15", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "6051550", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT GAIT/STR TRN EA15 #2", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "5705658", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 168.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT GAIT/STR TRN EA15 #2", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "6051552", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 112.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT HOSPICE MNTH", "code_information": [{"code": "G0051", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT HX ACT DRAIN PREV 90 DAYS", "code_information": [{"code": "G8560", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT IN THE HOME PER DIEM", "code_information": [{"code": "S9131", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INELIG FOOTWEAR EVALUATIO", "code_information": [{"code": "G8416", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INELIG FOR REF OTO EVAL", "code_information": [{"code": "G8561", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INELIG REF OTO EVAL", "code_information": [{"code": "G8566", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INFO INTO RECALL SYSTEM", "code_information": [{"code": "7010F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT INFOSYS ALARM 4 NXT MAMMO", "code_information": [{"code": "7025F", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT IONTOPHOR EA 15 BSC", "code_information": [{"code": "97033", "type": "CPT"}, {"code": "6051502", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 658.0, "discounted_cash": 493.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT IONTOPHORESIS 15 BSC", "code_information": [{"code": "97033", "type": "CPT"}, {"code": "5705272", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 658.0, "discounted_cash": 493.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT MANUAL THERAPY EA 15M", "code_information": [{"code": "97140", "type": "CPT"}, {"code": "5705178", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 518.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT MANUAL THERAPY EA 15M", "code_information": [{"code": "97140", "type": "CPT"}, {"code": "6055178", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 518.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT MECH PROS HT VALV", "code_information": [{"code": "G0043", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT MECH TRACTION BSC", "code_information": [{"code": "97012", "type": "CPT"}, {"code": "5705600", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 1643.0, "discounted_cash": 1232.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT MITRAL STENOSIS", "code_information": [{"code": "G0044", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NEUROMUSC RE-ED 15M-TELEMED", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "5707113", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 193.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT NEUROMUSC RE-ED 15M-TELEMED", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "6057112", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 193.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT NEUROMUSC RE-ED EA15", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "5705300", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT NEUROMUSC RE-ED EA15", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "6051542", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT NEUROMUSC RE-EDEA15#2", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "6051544", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 193.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT NO DOC HEAR LOSS", "code_information": [{"code": "G8567", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO HX ACT DRAIN 90 D", "code_information": [{"code": "G8562", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO REF OTO REAS NO SPEC", "code_information": [{"code": "G8563", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO REF OTOLO NO SPEC", "code_information": [{"code": "G8568", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NO REF, RN SPEC", "code_information": [{"code": "G0039", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT NOT ABLE TO PARTICIPATE", "code_information": [{"code": "G0037", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", 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"percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT ORTHO MGMT INIT EA 15MIN", "code_information": [{"code": "97760", "type": "CPT"}, {"code": "5707760", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 455.0, "discounted_cash": 341.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT ORTHO MGMT/TRN 15M-TELEMED", "code_information": [{"code": "97760", "type": "CPT"}, {"code": "5707757", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 455.0, "discounted_cash": 341.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT PERI DIALYSIS DUR MO", "code_information": [{"code": "G0052", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and 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"percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RCV HEDIA OUTPT DYLS FAC", "code_information": [{"code": "G8956", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT RE-EVAL", "code_information": [{"code": "97164", "type": "CPT"}, {"code": "5705209", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 1070.0, "discounted_cash": 802.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT RE-EVAL", "code_information": [{"code": "97164", "type": "CPT"}, {"code": "6051409", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 1070.0, "discounted_cash": 802.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT RE-EVAL EST PLAN CARE", "code_information": [{"code": "97164", "type": "CPT"}], "standard_charges": [{"minimum": 117.3, "maximum": 134.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 120.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 117.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 134.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 134.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT REF DOC OTO EVAL", "code_information": [{"code": "G8559", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT REF OTO EVAL", "code_information": [{"code": "G8564", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SCR TOB & CESS INT", "code_information": [{"code": "G0030", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT SFTY POS EXP W ANETH MVP", "code_information": [{"code": "G0059", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total 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{"description": "PT SLF CR/HM MGMT EA 15", "code_information": [{"code": "97535", "type": "CPT"}, {"code": "5705316", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 438.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT SPEC ALG RX-ONC TX OPTION", "code_information": [{"code": "794T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT SUBST PLSMA FRCT EA", "code_information": [{"code": "85611", "type": "CPT"}, {"code": "4104200", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.11, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SUBST PLSMA FRCT EA", "code_information": [{"code": "85611", "type": "CPT"}, {"code": "7258562", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.11, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT THER ACT EA 15", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "6051562", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 306.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT THER EX EA 15", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "5705296", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 320.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT THERAPEUTC ACT 15M-TELEMED", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "5707530", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 320.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT THERAPEUTC ACT 15M-TELEMED", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "6057530", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 320.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT THERAPEUTC ACT EA 15", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "5705312", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 306.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT THERAPEUTC EXER 15M-TELEMED", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "5707111", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 372.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT THERAPEUTC EXER 15M-TELEMED", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "6057110", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 372.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|95"}, {"description": "PT THERAPEUTC EXER EA15", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "6051538", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 320.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT THERAPEUTC MASSG EA15", "code_information": [{"code": "97124", "type": "CPT"}, {"code": "5705308", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT TRANS TO HOSP POST D/C", "code_information": [{"code": "G8914", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT US EA 15 BSC", "code_information": [{"code": "97035", "type": "CPT"}, {"code": "5705284", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 371.0, "discounted_cash": 278.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT US EA15 BSC", "code_information": [{"code": "97035", "type": "CPT"}, {"code": "6051514", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 371.0, "discounted_cash": 278.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT W IV AB GIVEN ON TIME", "code_information": [{"code": "G8916", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W IV AB NOT GIVEN ON TIME", "code_information": [{"code": "G8917", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ LMTED LIFE EXPEC", "code_information": [{"code": "G0050", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ABN LVEF B-BLOC NO RX", "code_information": [{"code": "G8452", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/ABN LVEF INELIG B-BLOC", "code_information": [{"code": "G8451", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/DXA NO RESULTS DOC", "code_information": [{"code": "G8400", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/DXA RESULTS DOCUMENT", "code_information": [{"code": "G8399", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT W/O PREOP ORDER IV AB PRO", "code_information": [{"code": "G8918", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT WK HRD/COND INIT 2 HR", "code_information": [{"code": "97545", "type": "CPT"}, {"code": "5705360", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 1228.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT WK HRD/COND INIT 2HR", "code_information": [{"code": "97545", "type": "CPT"}, {"code": "6051614", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 1228.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT, PN, HIST GRADE DOC", "code_information": [{"code": "G8721", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT, PN, HIST GRADE NOT DOC", "code_information": [{"code": "G8724", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT-FOCUSED HLTH RISK ASSMT", "code_information": [{"code": "96160", "type": "CPT"}], "standard_charges": [{"minimum": 45.46, "maximum": 51.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 45.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT/CAREGIVER TRAING HOME INR", "code_information": [{"code": "93792", "type": "CPT"}], "standard_charges": [{"minimum": 113.01, "maximum": 129.24, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 116.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 113.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 129.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 129.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 129.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT/PTN DECLN ASSESS", "code_information": [{"code": "G0036", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PT/PTN DECLN REFERRAL", "code_information": [{"code": "G0041", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PTA AQUA THER W/EXER EA 15M", "code_information": [{"code": "97113", "type": "CPT"}, {"code": "5700051", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 306.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA AQUA THER W/EXER EA15", "code_information": [{"code": "97113", "type": "CPT"}, {"code": "6050059", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 306.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA COMM/WK REINT TRN EA15M", "code_information": [{"code": "97537", "type": "CPT"}, {"code": "5700070", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 499.0, "discounted_cash": 374.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA E-STIM BASIC", "code_information": [{"code": "G0283", "type": "HCPCS"}, {"code": "5700023", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 201.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA E-STIM MAN EA 15 BSC", "code_information": [{"code": "97032", "type": "CPT"}, {"code": "6050049", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 372.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA E-STIM MANUAL 15 BSC", "code_information": [{"code": "97032", "type": "CPT"}, {"code": "5700037", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 372.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA GAIT/STR TRN EA 15", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "5700053", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA GAIT/STR TRN EA15", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "6050061", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA IONTOPHOR EA 15 BSC", "code_information": [{"code": "97033", "type": "CPT"}, {"code": "6050050", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 658.0, "discounted_cash": 493.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA IONTOPHORESIS 15 BSC", "code_information": [{"code": "97033", "type": "CPT"}, {"code": "5700038", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 658.0, "discounted_cash": 493.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA MANUAL THERAPY EA 15M", "code_information": [{"code": "97140", "type": "CPT"}, {"code": "6050065", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 518.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA MANUAL THRPY EA 15MIN", "code_information": [{"code": "97140", "type": "CPT"}, {"code": "5700057", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 518.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA MECH TRACTION BSC", "code_information": [{"code": "97012", "type": "CPT"}, {"code": "5700025", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 1643.0, "discounted_cash": 1232.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA NEUROMUSC RE-ED EA15", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "6050056", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA NEUROMUSC RE-ED EA15M#2", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "5700049", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 193.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA NEUROMUSC RE-ED EA15MIN", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "5700048", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA SLF CARE/HM MGMT EA 15M #2", "code_information": [{"code": "97535", "type": "CPT"}, {"code": "6050072", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 425.0, "discounted_cash": 318.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA SLF CR/HM MGMT EA 15MIN", "code_information": [{"code": "97535", "type": "CPT"}, {"code": "5700068", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 438.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA THER ACT EA 15", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "6050070", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 306.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA THER EX EA 15MIN", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "5700045", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 320.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA THERAPEUTC ACT EA 15MIN", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "5700063", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 306.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA THERAPEUTC EXER EA15", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "6050053", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 320.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA THERAPUTC MASSG EA15MIN", "code_information": [{"code": "97124", "type": "CPT"}, {"code": "5700055", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA US EA 15 BASIC", "code_information": [{"code": "97035", "type": "CPT"}, {"code": "5700040", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 371.0, "discounted_cash": 278.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA US EA15 BSC", "code_information": [{"code": "97035", "type": "CPT"}, {"code": "6050052", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 371.0, "discounted_cash": 278.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTCA W/ PLCMT BRACHYTX DEV", "code_information": [{"code": "C7533", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PTCH H VENTRALX LC STRP", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 805.98, "maximum": 805.98, "gross_charge": 3838.0, "discounted_cash": 2878.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 805.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTCH H VENTRIO LG OVAL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024617", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1431.78, "maximum": 1431.78, "gross_charge": 6818.0, "discounted_cash": 5113.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1431.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTCH H VENTRIO MED OVAL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1131.27, "maximum": 1131.27, "gross_charge": 5387.0, "discounted_cash": 4040.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1131.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTCH H VENTRIO SM OVAL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 766.08, "maximum": 766.08, "gross_charge": 3648.0, "discounted_cash": 2736.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 766.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTCH H VENTRIO ST LRG CIRCLE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 601.65, "maximum": 601.65, "gross_charge": 2865.0, "discounted_cash": 2148.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 601.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTCH H VENTRIO XL OVAL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2362.71, "maximum": 2362.71, "gross_charge": 11251.0, "discounted_cash": 8438.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2362.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTEN FULL GENE ANALYSIS", "code_information": [{"code": "235U", "type": "CPT"}], "standard_charges": [{"minimum": 600.0, "maximum": 600.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTEN GENE DUP/DELET VARIANT", "code_information": [{"code": "81323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 327.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 327.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTEN GENE FULL SEQUENCE", "code_information": [{"code": "81321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2248.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2248.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTEN GENE KNOWN FAM VARIANT", "code_information": [{"code": "81322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 218.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 218.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTT", "code_information": [{"code": "85730", "type": "CPT"}, {"code": "4105700", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.59, "gross_charge": 232.0, "discounted_cash": 174.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 30.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTT", "code_information": [{"code": "85730", "type": "CPT"}, {"code": "7255730", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.59, "gross_charge": 232.0, "discounted_cash": 174.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 30.59, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTT SUB EA FRACTION", "code_information": [{"code": "85732", "type": "CPT"}, {"code": "4105732", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.0, "gross_charge": 796.0, "discounted_cash": 597.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTT SUB EA FRACTION", "code_information": [{"code": "85732", "type": "CPT"}, {"code": "7255732", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.0, "gross_charge": 796.0, "discounted_cash": 597.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTT SUB EA FRACTION/2", "code_information": [{"code": "85732", "type": "CPT"}, {"code": "7252732", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.0, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTT SUB EA FRACTION/3", "code_information": [{"code": "85732", "type": "CPT"}, {"code": "7255617", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.0, "gross_charge": 175.0, "discounted_cash": 131.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTT SUB EA FRACTION/4", "code_information": [{"code": "85732", "type": "CPT"}, {"code": "7255733", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.0, "gross_charge": 175.0, "discounted_cash": 131.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUL ART BALLOON REPR PERCUT", "code_information": [{"code": "92997", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25570.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 661.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13169.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15059.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15059.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15059.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 661.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 661.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 661.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 661.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUL ART BALLOON REPR PERCUT", "code_information": [{"code": "92998", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25570.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULM DS IPF MRNA 190 GEN ALG", "code_information": [{"code": "81554", "type": "CPT"}], "standard_charges": [{"minimum": 5500.0, "maximum": 5500.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5500.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM REHAB W/O CONT OX", "code_information": [{"code": "94625", "type": "CPT"}, {"code": "5500051", "type": "CDM"}, {"code": "948", "type": "RC"}], "standard_charges": [{"minimum": 76.2, "maximum": 87.14, "gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM TISS VNTJ ALYS PREV CT", "code_information": [{"code": "807T", "type": "CPT"}], "standard_charges": [{"minimum": 145.43, "maximum": 145.43, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 145.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 145.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM TISS VNTJ ALYS W/CT", "code_information": [{"code": "808T", "type": "CPT"}], "standard_charges": [{"minimum": 280.06, "maximum": 280.06, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 280.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 280.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [{"code": "189", "type": "MS-DRG"}], "standard_charges": [{"minimum": 41017.75, "maximum": 51687.9, "estimated_discounted_cash": 61080.35, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41017.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 51687.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [{"code": "175", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19252.96, "maximum": 85839.94, "estimated_discounted_cash": 67321.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 77255.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37846.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42776.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52793.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81290.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 39822.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 55550.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 45010.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 47530.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 42051.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 85839.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 58659.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 58659.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 42051.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 47530.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 85839.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 47530.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 85839.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED 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"methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [{"code": "176", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10979.33, "maximum": 105687.93, "estimated_discounted_cash": 55516.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 95118.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 57429.57, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 31247.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 37069.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 39005.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 100086.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 60429.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 32879.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 105687.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 41188.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 63811.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 34719.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 63811.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 105687.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 41188.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 34719.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 63811.3, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 105687.93, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 41188.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 34719.56, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 33424.59, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 18749.4, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10979.33, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 74880.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26727.61, "methodology": "case rate"}, {"payer_name": "UNITED 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"payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE OXIM MULT DETRM", "code_information": [{"code": "94761", "type": "CPT"}, {"code": "5504761", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 5.94, "maximum": 5.94, "gross_charge": 801.0, "discounted_cash": 600.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE OXIMETRY-INIT", "code_information": [{"code": "94760", "type": "CPT"}, {"code": "3110660", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 2.9, "maximum": 2.9, "gross_charge": 261.0, "discounted_cash": 195.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE OXIMTRY CONTINUOUS", "code_information": [{"code": "94762", "type": "CPT"}, {"code": "5504762", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 33.38, "maximum": 211.75, "gross_charge": 674.0, "discounted_cash": 505.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN EA SEP/ADDL", "code_information": [{"code": "11105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN SINGLE LESION", "code_information": [{"code": "6901104", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN SINGLE LESION", "code_information": [{"code": "6901104", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN SINGLE LESION", "code_information": [{"code": "11104", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7607.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUNCT SHUNT TB/RESERV", "code_information": [{"code": "4911232", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3576.0, "discounted_cash": 2682.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCTURE ASPIR CYST BREAST", "code_information": [{"code": "19000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6005.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUNCTURE ASPIR CYST BRST EA", "code_information": [{"code": "19001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 71.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUNCTURE/CLEAR WINDPIPE", "code_information": [{"code": "31612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PURE TONE HEARING TEST AIR", "code_information": [{"code": "92551", "type": "CPT"}], "standard_charges": [{"minimum": 25.15, "maximum": 28.77, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUTTY BG FBRGRFT BIOACT MD 6CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4021049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1664.46, "maximum": 1664.46, "gross_charge": 7926.0, "discounted_cash": 5944.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1664.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUTTY BG FIBERGRFT GPS BIO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4028836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3727.92, "maximum": 3727.92, "gross_charge": 17752.0, "discounted_cash": 13314.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3727.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM GRAFTON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8134886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1762.32, "maximum": 1762.32, "gross_charge": 8392.0, "discounted_cash": 6294.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1762.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUTTY OP-1 BMP7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4014499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2052.96, "maximum": 2052.96, "gross_charge": 9776.0, "discounted_cash": 7332.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2052.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC 2ND+ INJ SITE", "code_information": [{"code": "64462", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC CONT INFUSION", "code_information": [{"code": "64463", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC SINGLE INJ SITE", "code_information": [{"code": "64461", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PWC GP 4 STD CAP CHAIR", "code_information": [{"code": "K0869", "type": "HCPCS"}], "standard_charges": [{"minimum": 5319.24, "maximum": 6082.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5475.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5319.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6082.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6082.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6082.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PWC GP 4 STD SEAT/BACK", "code_information": [{"code": "K0868", "type": "HCPCS"}], "standard_charges": [{"minimum": 5319.24, "maximum": 6082.96, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5475.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5319.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6082.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6082.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6082.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PWC GP2 STD SEAT ELEVATE CAP", "code_information": [{"code": "K0831", "type": "HCPCS"}], "standard_charges": [{"minimum": 4111.59, "maximum": 4701.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4232.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4111.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4701.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4701.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4701.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PWC GP2 STD SEAT ELEVATE S/B", "code_information": [{"code": "K0830", "type": "HCPCS"}], "standard_charges": [{"minimum": 4111.59, "maximum": 4701.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4232.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4111.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4701.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4701.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4701.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PWC GP4 HD MULT POW S/B", "code_information": [{"code": "K0886", "type": "HCPCS"}], "standard_charges": [{"minimum": 6510.01, "maximum": 7444.69, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6701.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6510.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7444.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7444.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7444.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PWC GP4 HD SING POW OPT S/B", "code_information": [{"code": "K0879", "type": "HCPCS"}], "standard_charges": [{"minimum": 6309.2, "maximum": 7215.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6494.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6309.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7215.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7215.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7215.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PWC GP4 STD MULT POW OPT CAP", "code_information": [{"code": "K0885", "type": "HCPCS"}], "standard_charges": [{"minimum": 7048.58, "maximum": 8060.59, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7255.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7048.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8060.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8060.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8060.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PWC GP4 STD MULT POW OPT S/B", "code_information": [{"code": "K0884", "type": "HCPCS"}], "standard_charges": [{"minimum": 7132.42, "maximum": 8156.47, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7342.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7132.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8156.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8156.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8156.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PWC GP4 STD SING POW OPT S/B", "code_information": [{"code": "K0877", "type": "HCPCS"}], "standard_charges": [{"minimum": 4671.82, "maximum": 5342.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4809.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4671.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5342.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5342.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5342.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PWC GP4 VHD SING POW OPT S/B", "code_information": [{"code": "K0880", "type": "HCPCS"}], "standard_charges": [{"minimum": 9873.15, "maximum": 11290.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10163.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9873.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11290.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11290.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11290.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PWC GP5 PED MULT POW OPT S/B", "code_information": [{"code": "K0891", "type": "HCPCS"}], "standard_charges": [{"minimum": 14216.73, "maximum": 16257.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14634.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14216.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16257.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16257.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16257.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PWC GP5 PED SING POW OPT S/B", "code_information": [{"code": "K0890", "type": "HCPCS"}], "standard_charges": [{"minimum": 10735.2, "maximum": 12276.52, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11050.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10735.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12276.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12276.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12276.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PWR PACK BASE ELEC VAD, REP", "code_information": [{"code": "Q0488", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PX SUP FEE ANTI-CAN SUB PRES", "code_information": [{"code": "Q0512", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY COMPLICATED", "code_information": [{"code": "50135", "type": "CPT"}], "standard_charges": [{"minimum": 1163.05, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1163.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1163.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1163.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1163.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1163.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/DRG PYELOSTOMY", "code_information": [{"code": "50125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1030.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1030.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1030.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1030.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1030.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/EXPLORATION", "code_information": [{"code": "50120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 984.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 984.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 984.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 984.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 984.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/REMOVAL CALCULUS", "code_information": [{"code": "50130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1070.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1070.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1070.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1070.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1070.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PYRAZINAMIDE 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310295", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PYRAZINAMIDE 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310295", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PYRIDOSTIGMINE 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310297", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PYRIDOSTIGMINE 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310297", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PYRIDOSTIGMINE180MGXRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310301", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PYRIDOSTIGMINE180MGXRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310301", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PYRIDOXL PHOSPH VIT B6", "code_information": [{"code": "84207", "type": "CPT"}, {"code": "7254207", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 143.26, "gross_charge": 377.0, "discounted_cash": 282.75, "setting": "both", "payers_information": 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{"description": "Professional Fees (Extension Of 096x And 097x) Hospital Visit", "code_information": [{"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees (Extension Of 096x And 097x) Medical Social Services", "code_information": [{"code": "984", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": 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"code_information": [{"code": "974", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees (Extension Of 096x) Occupational Therapy", "code_information": [{"code": "978", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees (Extension Of 096x) Operating Room", "code_information": [{"code": "975", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees (Extension Of 096x) Physical Therapy", "code_information": [{"code": "977", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees (Extension Of 096x) Radiology - Diagnostic", "code_information": [{"code": "972", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees (Extension Of 096x) Radiology - Therapeutic", "code_information": [{"code": "973", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees (Extension Of 096x) Respiratory Therapy", "code_information": [{"code": "976", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees (Extension Of 096x) Speech Pathology", "code_information": [{"code": "979", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees General", "code_information": [{"code": "960", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees Ophthalmology", "code_information": [{"code": "962", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees Other", "code_information": [{"code": "969", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees Psychiatric", "code_information": [{"code": "961", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE INSURANCE COMPANY/EVERCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Prolonged Inpatient Or Observation Hospital Service Each 30 Minutes Beyond First Hour", "code_information": [{"code": "99357", "type": "CPT"}], "standard_charges": [{"minimum": 86.56, "maximum": 86.56, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 86.56, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 86.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 86.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 86.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 86.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Prolonged Inpatient Or Observation Hospital Service First Hour", "code_information": [{"code": "99356", "type": "CPT"}], "standard_charges": [{"minimum": 86.26, "maximum": 86.26, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 86.26, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 86.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 86.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 86.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 86.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Prolonged Office Or Other Outpatient Service Each 30 Minutes Beyond First Hour", "code_information": [{"code": "99355", "type": "CPT"}], "standard_charges": [{"minimum": 93.83, "maximum": 93.83, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 93.83, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 93.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 93.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 93.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 93.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Prolonged Office Or Other Outpatient Service First Hour", "code_information": [{"code": "99354", "type": "CPT"}], "standard_charges": [{"minimum": 95.51, "maximum": 95.51, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Pros info op rpt", "code_information": [{"code": "G9304", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt disch to home by day#7", "code_information": [{"code": "G8818", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt inelig bmi calculation", "code_information": [{"code": "G8422", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt inelig for antidepres med", "code_information": [{"code": "G8128", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt inelig geno no antvir tx", "code_information": [{"code": "G8458", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt inelig lower extrem neuro", "code_information": [{"code": "G8406", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt inelig osteo screen measu", "code_information": [{"code": "G8401", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt inelig rna no antvir tx", "code_information": [{"code": "G8460", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt inelig; auto av fistula", "code_information": [{"code": "G8531", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt inelig; lo to no dter rsk", "code_information": [{"code": "G8464", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt no elg 4 order antbi give", "code_information": [{"code": "G8631", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt no elg phar ther osteo", "code_information": [{"code": "G8634", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt no elig for bp assess", "code_information": [{"code": "G8784", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt no hedia in outpt fac", "code_information": [{"code": "G8957", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt not disch to home day#7", "code_information": [{"code": "G8825", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt not elig for lvf test", "code_information": [{"code": "G8683", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt not treat w/antidepres12w", "code_information": [{"code": "G8127", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt reas no ecg", "code_information": [{"code": "G8706", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt rec ace/arb", "code_information": [{"code": "G8506", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt rec antivir treat hep c", "code_information": [{"code": "G8461", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pt treat w/antidepress12wks", "code_information": [{"code": "G8126", 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"drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310451", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 51.75, "setting": "both", "billing_class": "facility"}]}, {"description": "QUININE 324MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310483", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "QUININE 324MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310483", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "QUINUPR/DALFOPR 500MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2770", "type": "HCPCS"}, {"code": "5324419", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.56, "maximum": 3.96, "gross_charge": 2723.0, "discounted_cash": 2042.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUINUPR/DALFOPR 500MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2770", "type": "HCPCS"}, {"code": "5324419", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.56, "maximum": 3.96, "gross_charge": 2723.0, "discounted_cash": 2042.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Quantitative software measurements of cardiac volume, cardiac chambers volumes and left ventricular wall mass derived from CT scan(s) data of the chest/heart (with or without contrast)", "code_information": [{"code": "G0183", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "R HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7521", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7522", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R HRT ART/GRFT ANG HRT FLOW", "code_information": [{"code": "C7552", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93594", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93593", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&I HRT ART/VENT ANG DRG AD", "code_information": [{"code": "C7553", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7527", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7528", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93597", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT GFT ANG W/FLOW RESRV", "code_information": [{"code": "C7529", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R-T PRS SENSING EDRL GDN SYS", "code_information": [{"code": "777T", "type": "CPT"}], "standard_charges": [{"minimum": 4200.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R-T SPCTRL ALYS PRST8 TISS", "code_information": [{"code": "443T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RA TRACER ID OF SENTINL NODE", "code_information": [{"code": "38792", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RABIES ANTIBODY", "code_information": [{"code": "86790", "type": "CPT"}, {"code": "7256797", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.7, "gross_charge": 468.0, "discounted_cash": 351.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT PER150U IJ", "code_information": [{"code": "90376", "type": "CPT"}, {"code": "5323979", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 464.34, "maximum": 515.93, "gross_charge": 1515.0, "discounted_cash": 1136.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 464.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 515.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 515.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 515.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 515.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT PER150U IJ", "code_information": [{"code": "90376", "type": "CPT"}, {"code": "5323979", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 464.34, "maximum": 515.93, "gross_charge": 1515.0, "discounted_cash": 1136.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 464.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 515.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 515.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 515.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 515.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT&SOL HUMAN IM/SC", "code_information": [{"code": "90377", "type": "CPT"}], "standard_charges": [{"minimum": 200.03, "maximum": 222.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 200.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 222.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 222.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 222.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 222.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG IM/SC 150U IJ", "code_information": [{"code": "90375", "type": "CPT"}, {"code": "5323970", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 251.87, "maximum": 279.85, "gross_charge": 1352.0, "discounted_cash": 1014.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 251.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 279.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 279.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 279.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 279.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG IM/SC 150U IJ", "code_information": [{"code": "90375", "type": "CPT"}, {"code": "5323970", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 251.87, "maximum": 279.85, "gross_charge": 1352.0, "discounted_cash": 1014.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 251.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 279.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 279.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 279.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 279.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE ID", "code_information": [{"code": "90676", "type": "CPT"}], "standard_charges": [{"minimum": 221.24, "maximum": 245.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 221.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 245.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 245.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 245.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 245.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE IM IJ", "code_information": [{"code": "90675", "type": "CPT"}, {"code": "5323974", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 282.31, "maximum": 313.68, "gross_charge": 1913.0, "discounted_cash": 1434.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 282.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 313.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 313.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 313.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 313.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE IM IJ", "code_information": [{"code": "90675", "type": "CPT"}, {"code": "5323974", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 282.31, "maximum": 313.68, "gross_charge": 1913.0, "discounted_cash": 1434.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 282.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 313.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 313.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 313.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 313.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD EXC LESION UP TO 1.25 CM", "code_information": [{"code": "D7410", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM DSTL/SHFT HUM", "code_information": [{"code": "24150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 963.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 963.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 963.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 963.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 963.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E 5 CM+", "code_information": [{"code": "24079", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E <5CM", "code_information": [{"code": "24077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECT ABD TUMOR 5 CM/>", "code_information": [{"code": "22905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECT HAND TUMOR 3 CM/>", "code_information": [{"code": "26118", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECT HAND TUMOR < 3 CM", "code_information": [{"code": "26117", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECTION TUM RADIAL H/N", "code_information": [{"code": "24152", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD SORCE SUPV HANDLG", "code_information": [{"code": "77790", "type": "CPT"}, {"code": "5107419", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 98.91, "gross_charge": 471.0, "discounted_cash": 353.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 98.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 85.3, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 90.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 90.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 90.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 90.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 90.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD TX DLVR>1MEV COMPLX", "code_information": [{"code": "77412", "type": "CPT"}, {"code": "5107744", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 772.8, "gross_charge": 3680.0, "discounted_cash": 2760.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 772.8, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 213.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 350.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 213.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 213.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 213.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 213.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD TX DLVR>1MEV INTER", "code_information": [{"code": "77407", "type": "CPT"}, {"code": "5107741", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 388.87, "gross_charge": 1587.0, "discounted_cash": 1190.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 333.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 350.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 388.87, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 184.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD TX DLVR>1MEV SIMPLE", "code_information": [{"code": "77402", "type": "CPT"}, {"code": "5107740", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 269.85, "gross_charge": 1285.0, "discounted_cash": 963.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 269.85, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 144.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 182.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 202.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 202.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 202.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 202.68, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 144.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 144.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 144.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 144.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIAL KERATOTOMY", "code_information": [{"code": "65771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY MANAGEMENT", "code_information": [{"code": "77431", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 304.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 304.82, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 98.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 98.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 98.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 98.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 98.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 229.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 229.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 72.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 162.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 180.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 180.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 180.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 180.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 72.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 72.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 72.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 72.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 344.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 344.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 108.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 245.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 272.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 272.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 272.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 272.17, "methodology": "fee schedule"}, {"payer_name": "CORVEL", 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schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 187.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 431.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 479.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 479.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 479.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 479.38, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 187.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 187.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 187.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 187.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECT ABD TUMOR<5CM", "code_information": [{"code": "22904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION OF ELBOW", "code_information": [{"code": "24149", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIESSE INJECTION", "code_information": [{"code": "Q2026", "type": "HCPCS"}], "standard_charges": [{"minimum": 278.92, "maximum": 309.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 278.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 309.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 309.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 309.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 309.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIOTHERAPY", "code_information": [{"code": "849", "type": "MS-DRG"}], "standard_charges": [{"minimum": 89960.82, "maximum": 113362.77, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 89960.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 113362.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIUM RA223 DICHLORIDE THER", "code_information": [{"code": "A9606", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.02, "maximum": 227.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 205.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 227.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 227.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 227.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 227.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADPHARM TX IV", "code_information": [{"code": "79101", "type": "CPT"}, {"code": "5209101", "type": "CDM"}, {"code": "342", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 488.04, "gross_charge": 2324.0, "discounted_cash": 1743.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 488.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 307.33, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 199.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 199.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 199.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 199.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 199.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 249.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 249.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADPHARM TX ORAL", "code_information": [{"code": "79005", "type": "CPT"}, {"code": "5209005", "type": "CDM"}, {"code": "342", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 371.91, "gross_charge": 1771.0, "discounted_cash": 1328.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 371.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 302.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 184.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 184.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 184.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 184.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 184.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 249.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 249.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADPHYSICS CONSULT P/WK", "code_information": [{"code": "77336", "type": "CPT"}, {"code": "5107336", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 455.49, "gross_charge": 2169.0, "discounted_cash": 1626.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 455.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 336.2, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 99.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 193.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 99.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 99.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 99.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 99.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADPHYSICS SPEC CONSULT", "code_information": [{"code": "77370", "type": "CPT"}, {"code": "5107370", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 446.59, "gross_charge": 1497.0, "discounted_cash": 1122.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 314.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 446.59, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 155.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 193.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 155.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 155.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 155.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 155.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADTHER SIMULATION CMPLX", "code_information": [{"code": "77290", "type": "CPT"}, {"code": "5107290", "type": "CDM"}, {"code": "333", "type": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS 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"setting": "both", "billing_class": "facility"}]}, {"description": "RANOLAZINE 500MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310520", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RAPID DESENSITIZATION", "code_information": [{"code": "95180", "type": "CPT"}], "standard_charges": [{"minimum": 154.98, "maximum": 542.27, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 154.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 488.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 474.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 542.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 542.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 542.27, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 154.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 154.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 154.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6739.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS GEN DNA ALYS EA COMP", "code_information": [{"code": "213U", "type": "CPT"}], "standard_charges": [{"minimum": 2709.95, "maximum": 2709.95, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2709.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2709.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS GEN DNA ALYS PROBAND", "code_information": [{"code": "212U", "type": "CPT"}], "standard_charges": [{"minimum": 5475.2, "maximum": 5475.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1263.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1263.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS WHL GEN SEQ BLD/SLV", "code_information": [{"code": "336U", "type": "CPT"}], "standard_charges": [{"minimum": 2574.65, "maximum": 2574.65, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2574.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2574.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS WHL GEN SEQ FETA", "code_information": [{"code": "335U", "type": "CPT"}], "standard_charges": [{"minimum": 5224.6, "maximum": 5224.6, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5224.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5224.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS XOM DNA ALYS EA COMP", "code_information": [{"code": "215U", "type": "CPT"}], "standard_charges": [{"minimum": 2574.65, "maximum": 2574.65, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2574.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2574.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RARE DS XOM 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"setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 339.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 377.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 377.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 377.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 377.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC AG EXCPT ABO/RHO EA", "code_information": [{"code": "86905", "type": "CPT"}, {"code": "4106095", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.49, "gross_charge": 462.0, "discounted_cash": 346.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 19.49, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.34, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART 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"plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.34, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC 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"billing_class": "facility"}]}, {"description": "RBC AUTO", "code_information": [{"code": "85041", "type": "CPT"}, {"code": "7255041", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.33, "gross_charge": 59.0, "discounted_cash": 44.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DEPLETION OF HARVEST", "code_information": [{"code": "38212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNOTYP 10 BLD GROUPS", "code_information": [{"code": "84U", "type": "CPT"}], "standard_charges": [{"minimum": 720.0, "maximum": 720.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNOTYP 16 BLD GROUPS", "code_information": [{"code": "246U", "type": "CPT"}], "standard_charges": [{"minimum": 720.0, "maximum": 720.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNTYP 12 BLD GRP GEN", "code_information": [{"code": "282U", "type": "CPT"}], "standard_charges": [{"minimum": 720.0, "maximum": 720.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC DNA HEA 35 AG 11 BLD GRP", "code_information": [{"code": "1U", "type": "CPT"}], "standard_charges": [{"minimum": 720.0, "maximum": 720.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC MECHANICAL FRAGILITY", "code_information": [{"code": "85547", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 43.87, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.92, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC SED RATE AUTOMATED", "code_information": [{"code": "85652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3.77, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RBC WASHED AUTO", "code_information": [{"code": "P9022", "type": "HCPCS"}, {"code": "3219022", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"gross_charge": 2639.0, "discounted_cash": 1979.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RBTCS DAVN LVL II EA 15 MIN", "code_information": [{"code": "3213573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6178.0, "discounted_cash": 4633.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RBTCS DAVN LVL II INT 30 MIN", "code_information": [{"code": "3213572", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 15539.0, "discounted_cash": 11654.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RBTCS DAVN LVL III EA 15 MIN", "code_information": [{"code": "3213575", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7002.0, "discounted_cash": 5251.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RBTCS DAVN LVL III INT 30 MIN", "code_information": [{"code": "3213574", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 18008.0, "discounted_cash": 13506.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RBTCS DAVN LVL IV EA 15 MIN", "code_information": [{"code": "3213577", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8394.0, "discounted_cash": 6295.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RBTCS DAVN LVL IV INT 30 MIN", "code_information": [{"code": "3213576", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21545.0, "discounted_cash": 16158.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96931", "type": "CPT"}], "standard_charges": [{"minimum": 359.91, "maximum": 411.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 370.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 359.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 411.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 411.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 411.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96933", "type": "CPT"}], "standard_charges": [{"minimum": 93.05, "maximum": 106.41, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 95.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 93.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 106.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 106.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 106.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RCRDR LOOP REVEAL", "code_information": [{"code": "C1764", "type": "HCPCS"}, {"code": "4001500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4669.56, "maximum": 4669.56, "gross_charge": 22236.0, "discounted_cash": 16677.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4669.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RD CARBON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 353.01, "maximum": 353.01, "gross_charge": 1681.0, "discounted_cash": 1260.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 353.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RD CARBON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 263.55, "maximum": 263.55, "gross_charge": 1255.0, "discounted_cash": 941.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 263.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RD SPINAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 272.58, "maximum": 272.58, "gross_charge": 1298.0, "discounted_cash": 973.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 272.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RD SPINAL 1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.32, "maximum": 271.32, "gross_charge": 1292.0, "discounted_cash": 969.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 271.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RD SPINAL 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 677.67, "maximum": 677.67, "gross_charge": 3227.0, "discounted_cash": 2420.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 677.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RD SPINAL 3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1053.57, "maximum": 1053.57, "gross_charge": 5017.0, "discounted_cash": 3762.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1053.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RD SPINAL 4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1958.25, "maximum": 1958.25, "gross_charge": 9325.0, "discounted_cash": 6993.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1958.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RD SPINAL 5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2929.92, "maximum": 2929.92, "gross_charge": 13952.0, "discounted_cash": 10464.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2929.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RE-EXPLORATION OF CHEST", "code_information": [{"code": "32120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RE-EXPLORE PARATHYROIDS", "code_information": [{"code": "60502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1207.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1207.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1207.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1207.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1207.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "READY GRADIENT GAUNTLET", "code_information": [{"code": "S8428", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "READY GRADIENT GLOVE", "code_information": [{"code": "S8427", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "READY GRADIENT SLEEV/GLOV", "code_information": [{"code": "S8421", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "READY GRADIENT SLEEVE", "code_information": [{"code": "S8424", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF HAND", "code_information": [{"code": "25335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF KNEE", "code_information": [{"code": "27455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 938.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 938.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 938.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 938.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 938.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF KNEE", "code_information": [{"code": "27457", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 963.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 963.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 963.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 963.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 963.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF LOWER LEG", "code_information": [{"code": "27712", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1074.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1074.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1074.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1074.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1074.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF TENDONS", "code_information": [{"code": "26437", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF THIGH BONE", "code_information": [{"code": "27454", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1276.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1276.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1276.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1276.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1276.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REAS NO ADHERE THERAPY", "code_information": [{"code": "G8854", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69636", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69637", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD OUTER EAR CANAL", "code_information": [{"code": "69310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD OUTER EAR CANAL", "code_information": [{"code": "69320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEIVER/TRANSMITTER, NEURO", "code_information": [{"code": "C1816", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECEPT ASSAY NON-ENDOCRN", "code_information": [{"code": "84238", "type": "CPT"}, {"code": "7253557", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 186.48, "gross_charge": 384.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 186.48, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 51.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 51.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 51.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 51.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 51.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 36.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECEPT ASSAY NON-ENDOCRN/7", "code_information": [{"code": "84238", "type": "CPT"}, {"code": "7258443", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 186.48, "gross_charge": 193.0, "discounted_cash": 144.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 186.48, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 51.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 51.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 51.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 51.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 51.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 36.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1095.12, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1095.12, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1095.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1095.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1095.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35302", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1133.6, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1133.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1133.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1133.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1133.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1244.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1244.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1244.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1244.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1244.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1294.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1294.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1294.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1294.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1294.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1244.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1244.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1244.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1244.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1244.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 460.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 460.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 460.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 460.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 460.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35311", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1568.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1568.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1568.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1568.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1568.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 934.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 934.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 934.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 934.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 934.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1519.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1519.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1519.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1519.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1519.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1444.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1444.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1444.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1444.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1444.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35351", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1334.71, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1334.71, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1334.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1334.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1334.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1087.71, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1087.71, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1087.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1087.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1087.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1642.64, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1642.64, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1642.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1642.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1642.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35363", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1760.12, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1760.12, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1760.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1760.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1760.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 866.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 866.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 866.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 866.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 866.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35372", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1036.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1036.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1036.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1036.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1036.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECON, CTA FOR SURG PLAN", "code_information": [{"code": "G0288", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/FIXATION", "code_information": [{"code": "21196", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1446.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1446.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1446.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1446.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1446.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/GRAFT", "code_information": [{"code": "21194", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1392.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1392.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1392.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1392.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1392.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/O FIXATION", "code_information": [{"code": "21195", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1335.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1335.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1335.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1335.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1335.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/O GRAFT", "code_information": [{"code": "21193", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1221.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1221.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1221.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1221.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1221.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW SEGMENT", "code_information": [{"code": "21198", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW W/ADVANCE", "code_information": [{"code": "21199", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ANKLE JOINT", "code_information": [{"code": "27702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 998.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 998.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 998.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 998.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 998.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT BRONCHUS", "code_information": [{"code": "31775", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1418.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1418.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1418.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1418.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1418.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT FOOT", "code_information": [{"code": "28360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 957.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 957.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 957.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 957.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 957.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1030.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1030.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1030.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1030.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1030.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21182", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1983.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1983.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1983.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1983.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1983.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21183", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2270.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2270.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2270.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2270.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2270.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21184", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2350.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2350.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2350.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2350.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2350.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24362", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW LAT LIGMNT", "code_information": [{"code": "24344", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW MED LIGMNT", "code_information": [{"code": "24346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21179", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1437.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1437.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1437.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1437.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1437.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1627.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1627.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1627.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1627.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1627.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT EXTRA FINGER", "code_information": [{"code": "26587", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT FINGER JOINT", "code_information": [{"code": "26545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT FINGER JOINT", "code_information": [{"code": "26548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT HEAD OF RADIUS", "code_information": [{"code": "24365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT HEAD OF RADIUS", "code_information": [{"code": "24366", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT INJURED CHEST", "code_information": [{"code": "32820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1361.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1361.59, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1361.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1361.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1361.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LARYNX & PHARYNX", "code_information": [{"code": "31395", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2866.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2866.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2866.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2866.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2866.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40527", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21247", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1598.07, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1598.07, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1598.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1598.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1598.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1386.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1386.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1386.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1386.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1386.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT MAXILLA SEGMENT", "code_information": [{"code": "D7947", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT MIDFACE NO GRAFT", "code_information": [{"code": "D7948", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT MIDFACE W/GRAFT", "code_information": [{"code": "D7949", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", "code_information": [{"code": "21172", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1697.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1697.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1697.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1697.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1697.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", "code_information": [{"code": "21175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2007.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2007.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2007.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2007.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2007.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT SHOULDER JOINT", "code_information": [{"code": "23470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1210.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1210.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1210.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1210.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1210.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT SHOULDER JOINT", "code_information": [{"code": "23472", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 25867.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1488.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1488.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1488.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1488.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1488.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ULNA/RADIOULNAR", "code_information": [{"code": "25337", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT UPPER JAW BONE", "code_information": [{"code": "21206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA STAGE 1", "code_information": [{"code": "53420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA STAGE 2", "code_information": [{"code": "53425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA/BLADDER", "code_information": [{"code": "53431", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT VENA CAVA", "code_information": [{"code": "34502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1584.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1584.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1584.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1584.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1584.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1179.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1179.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1179.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1179.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1179.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1414.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1414.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1414.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1414.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1414.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25443", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25444", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION ANKLE JOINT", "code_information": [{"code": "27703", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1140.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1140.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1140.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1140.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1140.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27427", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27428", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27429", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION MAXILLA TOTAL", "code_information": [{"code": "D7946", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF ANUS", "code_information": [{"code": "46753", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF BILE DUCTS", "code_information": [{"code": "47800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1437.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1437.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1437.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1437.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1437.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21123", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67971", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67973", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67974", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67975", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF HIP SOCKET", "code_information": [{"code": "27120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1266.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1266.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1266.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1266.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1266.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF HIP SOCKET", "code_information": [{"code": "27122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1094.44, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1094.44, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1094.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1094.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1094.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21245", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21249", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21242", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF LOWER JAW", "code_information": [{"code": "21244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MIDFACE", "code_information": [{"code": "21188", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1630.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1630.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1630.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1630.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1630.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40843", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40844", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NAIL BED", "code_information": [{"code": "11762", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 120.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 120.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 120.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 120.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 120.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF ORBIT", "code_information": [{"code": "21256", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1132.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1132.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1132.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1132.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1132.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF PYLORUS", "code_information": [{"code": "43800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 848.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 848.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 848.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 848.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 848.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF STERNUM", "code_information": [{"code": "21740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1052.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1052.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1052.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1052.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1052.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF THROAT", "code_information": [{"code": "42950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1157.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1157.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1157.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1157.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1157.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54318", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54324", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF WINDPIPE", "code_information": [{"code": "31766", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1797.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1797.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1797.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1797.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1797.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION TONGUE FOLD", "code_information": [{"code": "41520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECOVERY EA ADDL 15 MIN", "code_information": [{"code": "3223571", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 2255.0, "discounted_cash": 1691.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RECOVERY EA ADDL 15MIN", "code_information": [{"code": "6400002", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 702.0, "discounted_cash": 526.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RECOVERY INIT 30 MIN", "code_information": [{"code": "3223570", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 719.0, "discounted_cash": 539.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RECOVERY INIT 30 MIN", "code_information": [{"code": "6400001", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 2810.0, "discounted_cash": 2107.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITH CC", "code_information": [{"code": "333", "type": "MS-DRG"}], "standard_charges": [{"minimum": 77765.72, "maximum": 97995.31, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 77765.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 97995.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITH MCC", "code_information": [{"code": "332", "type": "MS-DRG"}], "standard_charges": [{"minimum": 120214.48, "maximum": 151486.47, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 120214.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 151486.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITHOUT CC/MCC", "code_information": [{"code": "334", "type": "MS-DRG"}], "standard_charges": [{"minimum": 54381.56, "maximum": 68528.1, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 54381.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 68528.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECTAL SENSATION TEST", "code_information": [{"code": "91120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 493.94, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 493.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 493.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 493.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 493.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 493.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [{"code": "811", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3821.11, "maximum": 58754.51, "estimated_discounted_cash": 92220.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 33586.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6008.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17188.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8938.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 35340.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9405.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6322.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18086.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19098.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6676.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 37318.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9931.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9931.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6676.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19098.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 37318.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9931.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 37318.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6676.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19098.32, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6302.42, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 3821.11, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10604.91, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 23800.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46625.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 58754.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELL DISORDERS WITHOUT MCC", "code_information": [{"code": "812", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4302.5, "maximum": 38416.57, "estimated_discounted_cash": 62803.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13866.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9464.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24667.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6633.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14591.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6979.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25956.03, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9959.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7370.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10516.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27408.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15407.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15407.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7370.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27408.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10516.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15407.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7370.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27408.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10516.68, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7954.01, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5821.03, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4302.5, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 17345.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30486.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38416.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS MULTIPLE", "code_information": [{"code": "78121", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 489.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 136.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 136.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 136.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 136.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 136.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS SINGLE", "code_information": [{"code": "78120", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 235.84, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 101.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 101.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 101.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 101.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 101.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL SEQUESTRATION", "code_information": [{"code": "78140", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 475.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 475.42, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 190.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 190.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 190.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 190.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 190.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL SURVIVAL STUDY", "code_information": [{"code": "78130", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 383.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 383.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 176.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 176.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 176.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 176.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 176.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDO COMPL CARDIAC ANOMALY", "code_information": [{"code": "33622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDO ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37192", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCE BOWEL OBSTRUCTION", "code_information": [{"code": "44050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 854.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 854.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 854.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 854.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 854.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCE TESTIS TORSION", "code_information": [{"code": "54600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCING SUBSTANCES/2", "code_information": [{"code": "84999", "type": "CPT"}, {"code": "4109440", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "gross_charge": 209.0, "discounted_cash": 156.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCT COMPND FACIAL BONE FX", "code_information": [{"code": "D7780", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCT SIMPLE FACIAL BONE FX", "code_information": [{"code": "D7680", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FACIAL BONES", "code_information": [{"code": "21209", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21137", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21138", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21139", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF RECTAL PROLAPSE", "code_information": [{"code": "45900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1528.33, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1528.33, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1528.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1528.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1528.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62117", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1747.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1747.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1747.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1747.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1747.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REEXPLORATION PELVIC WOUND", "code_information": [{"code": "49014", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REF FOR OTO EVAL", "code_information": [{"code": "G8856", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REF TO THERAPY", "code_information": [{"code": "G0042", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFILL IMP PMP/RSV SYST", "code_information": [{"code": "96522", "type": "CPT"}, {"code": "6923000", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 133.7, "maximum": 133.7, "gross_charge": 1116.0, "discounted_cash": 837.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFILL IMP PMP/RSV SYST", "code_information": [{"code": "96522", "type": "CPT"}, {"code": "6923000", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 133.7, "maximum": 133.7, "gross_charge": 1116.0, "discounted_cash": 837.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFILL/MAINT PRT PMP", "code_information": [{"code": "96521", "type": "CPT"}, {"code": "6926522", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 168.23, "maximum": 291.54, "gross_charge": 1927.0, "discounted_cash": 1445.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 168.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 168.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 168.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 168.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 168.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFILL/MAINT PRT PMP", "code_information": [{"code": "96521", "type": "CPT"}, {"code": "6926522", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 168.23, "maximum": 291.54, "gross_charge": 1927.0, "discounted_cash": 1445.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 168.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 168.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 168.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 168.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 168.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR H MLT INJ", "code_information": [{"code": "490T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR HANDS", "code_information": [{"code": "489T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITH CC/MCC", "code_information": [{"code": "945", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2372.0, "maximum": 2989.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2372.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2989.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITHOUT CC/MCC", "code_information": [{"code": "946", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2372.0, "maximum": 2989.0, "estimated_discounted_cash": 44189.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2372.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2989.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "REIMPLANT ARTERY EACH", "code_information": [{"code": "35697", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 155.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 155.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 155.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 155.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 155.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1128.64, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1128.64, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1128.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1128.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1128.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50782", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1143.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1143.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1143.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1143.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1143.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50783", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1182.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1182.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1182.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1182.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1182.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1245.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1245.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1245.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1245.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1245.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REIMPLANTATION OF KIDNEY", "code_information": [{"code": "50380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1737.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1737.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1737.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1737.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1737.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE CLAVICLE", "code_information": [{"code": "23490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE EYE WALL", "code_information": [{"code": "67250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE HIP BONES", "code_information": [{"code": "27187", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 990.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 990.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 990.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 990.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 990.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE HUMERUS", "code_information": [{"code": "24498", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE PULMONARY ARTERY", "code_information": [{"code": "33690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1181.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1181.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1181.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1181.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1181.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS", "code_information": [{"code": "25490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS AND ULNA", "code_information": [{"code": "25492", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE SHOULDER BONES", "code_information": [{"code": "23491", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE THIGH", "code_information": [{"code": "27495", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1125.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1125.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1125.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1125.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1125.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE TIBIA", "code_information": [{"code": "27745", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE ULNA", "code_information": [{"code": "25491", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE/GRAFT EYE WALL", "code_information": [{"code": "67255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINNERVATE LARYNX", "code_information": [{"code": "31590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINSERT OCULAR IMPLANT", "code_information": [{"code": "65155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINSERT SPINAL FIXATION", "code_information": [{"code": "22849", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1272.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1272.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1272.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1272.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1272.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE ENCIRCLING MATERIAL", "code_information": [{"code": "67115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE EYE TISSUE", "code_information": [{"code": "67343", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1889.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1889.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1889.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1889.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1889.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2011.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2011.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2011.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2011.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2011.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FINGER CONTRACTURE", "code_information": [{"code": "26525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FOOT/TOE NERVE", "code_information": [{"code": "64726", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FOREARM/HAND TENDON", "code_information": [{"code": "26449", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE HAND/FINGER TENDON", "code_information": [{"code": "26445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE INNER EAR CANAL", "code_information": [{"code": "69960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1937.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1937.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1937.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1937.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1937.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE KNUCKLE CONTRACTURE", "code_information": [{"code": "26520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE MIDDLE EAR BONE", "code_information": [{"code": "69650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE MUSCLES OF HAND", "code_information": [{"code": "26593", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF BIG TOE", "code_information": [{"code": "28240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF EYE FLUID", "code_information": [{"code": "67015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT CONTRACTURE", "code_information": [{"code": "28270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDON", "code_information": [{"code": "28220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 203.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 203.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 203.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 203.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 203.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDON", "code_information": [{"code": "28225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDONS", "code_information": [{"code": "28222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDONS", "code_information": [{"code": "28226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LOWER LEG TENDON", "code_information": [{"code": "27680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LOWER LEG TENDONS", "code_information": [{"code": "27681", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LUNG", "code_information": [{"code": "32220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1581.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1581.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1581.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1581.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1581.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF MIDFOOT JOINT", "code_information": [{"code": "28260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF MIDFOOT JOINT", "code_information": [{"code": "28264", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SHOULDER LIGAMENT", "code_information": [{"code": "23415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 846.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 846.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 846.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 846.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 846.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1213.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1213.59, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1213.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1213.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1213.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF TOE JOINT EACH", "code_information": [{"code": "28272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1161.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1161.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1161.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1161.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1161.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50722", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1012.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1012.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1012.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1012.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1012.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 902.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 902.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 902.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 902.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 902.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM & FINGER TENDON", "code_information": [{"code": "26442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26123", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM/FINGER TENDON", "code_information": [{"code": "26440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE SHOULDER JOINT", "code_information": [{"code": "23020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE SPINAL CORD LUMBAR", "code_information": [{"code": "63200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1415.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1415.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1415.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1415.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1415.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE THUMB CONTRACTURE", "code_information": [{"code": "26508", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE WRIST/FOREARM TENDON", "code_information": [{"code": "25295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE/REVISE URETER", "code_information": [{"code": "50725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1118.15, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1118.15, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1118.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1118.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1118.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELIEVE BLADDER CONTRACTURE", "code_information": [{"code": "52640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 20574.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELIEVE CRANIAL PRESSURE", "code_information": [{"code": "61345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1900.99, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1900.99, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1900.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1900.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1900.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELIEVE INNER EYE PRESSURE", "code_information": [{"code": "65820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELIEVE PRESSURE ON NERVE(S)", "code_information": [{"code": "64722", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELOC SKIN POCKET PLS GEN", "code_information": [{"code": "416T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELOCATE POCKET FOR DEFIB", "code_information": [{"code": "33223", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "estimated_discounted_cash": 12026.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELOCATE SKIN PKT AICD", "code_information": [{"code": "4613223", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12727.0, "discounted_cash": 9545.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOCATION OF TESTIS(ES)", "code_information": [{"code": "54680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELOCATION POCKET PACEMAKER", "code_information": [{"code": "33222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "estimated_discounted_cash": 5876.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM AICD PULS GEN", "code_information": [{"code": "4613241", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5659.0, "discounted_cash": 4244.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEV W/O FLAP", "code_information": [{"code": "D7300", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEVICE W/FLAP", "code_information": [{"code": "D7299", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM ENDO VENA CAVA FILTR", "code_information": [{"code": "4617193", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 14717.0, "discounted_cash": 11037.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REM ENDO VENA CAVA FILTR", "code_information": [{"code": "4917193", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10251.0, "discounted_cash": 7688.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REM ENDOVAS VENA CAVA FILTER", "code_information": [{"code": "37193", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL ICPMS", "code_information": [{"code": "93297", "type": "CPT"}], "standard_charges": [{"minimum": 52.19, "maximum": 59.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 52.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL SCRMS", "code_information": [{"code": "93298", "type": "CPT"}], "standard_charges": [{"minimum": 52.19, "maximum": 59.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 52.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", 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100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOT IMG SUB BY PT, NON E/M", "code_information": [{"code": "G2250", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.11, "maximum": 19.57, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER 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ARRANGEMENT", "standard_charge_dollar": 58.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG TECH SUPP", "code_information": [{"code": "93229", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV VERT IDRL BDY LMBR/SAC", "code_information": [{"code": "63307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2050.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2050.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2050.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2050.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2050.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV VERT IDRL BDY THRCLMBR", "code_information": [{"code": "63306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2251.56, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2251.56, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2251.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2251.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2251.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV VERT XDRL BDY LMBR/SAC", "code_information": [{"code": "63303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2016.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2016.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2016.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2016.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2016.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV VERTBR DCMPRN THRCLMBR", "code_information": [{"code": "63087", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2293.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2293.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2293.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2293.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2293.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV/REPLC PENIS PROS COMP", "code_information": [{"code": "54411", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1054.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV/REPLC UR SPHINCTR COMP", "code_information": [{"code": "53448", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.17, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.17, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL ABDOMEN LYMPH NODES", "code_information": [{"code": "38564", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 665.77, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 665.77, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 665.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 665.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 665.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL ALLOGRAFT PANCREAS", "code_information": [{"code": "48556", "type": "CPT"}], "standard_charges": [{"minimum": 1117.4, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1117.4, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1117.4, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1117.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1117.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1117.4, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL ANTERIOR INSTRMJ", "code_information": [{"code": "22855", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1077.99, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1077.99, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1077.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1077.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1077.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL BILIARY DRG CATH", "code_information": [{"code": "47537", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL COMPLETE IIMS", "code_information": [{"code": "530T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL DUCT GLBLDR CALCULI", "code_information": [{"code": "47544", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB SKIN/AREOLAR TISS", "code_information": [{"code": "D7530", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY GUM", "code_information": [{"code": "41805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 134.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 134.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 134.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 134.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 134.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY JAWBONE", "code_information": [{"code": "41806", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 172.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 172.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 172.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 172.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 172.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY MOUTH", "code_information": [{"code": "40804", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY MOUTH", "code_information": [{"code": "40805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 176.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 176.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 176.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 176.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 176.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL IIMS ELECTRODE ONLY", "code_information": [{"code": "531T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL IIMS IMPLT MNTR ONLY", "code_information": [{"code": "532T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPLANT SUPERFICIAL", "code_information": [{"code": "20670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL KIDNEY OPEN COMPLEX", "code_information": [{"code": "50225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1227.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1227.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1227.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1227.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1227.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL KIDNEY OPEN RADICAL", "code_information": [{"code": "50230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1320.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1320.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1320.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1320.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1320.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12069.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7286.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANAL FISSURE", "code_information": [{"code": "46200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANAL TAGS", "code_information": [{"code": "46230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE BONE", "code_information": [{"code": "28130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE IMPLANT", "code_information": [{"code": "27704", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE/HEEL LESION", "code_information": [{"code": "28100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANORECTAL LESION", "code_information": [{"code": "45108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARM ARTERY CLOT", "code_information": [{"code": "34111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 634.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 634.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 634.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 634.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 634.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 963.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 963.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 963.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 963.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 963.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34051", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 993.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 993.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 993.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 993.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 993.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 635.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 635.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 635.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 635.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 635.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1447.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1447.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1447.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1447.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1447.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 980.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 980.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 980.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 980.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 980.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER", "code_information": [{"code": "51570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1518.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1518.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1518.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1518.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1518.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1881.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1881.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1881.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1881.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1881.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2178.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2178.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2178.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2178.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2178.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER CYST", "code_information": [{"code": "51500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 887.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 887.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 887.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 887.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 887.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 797.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 797.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 797.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 797.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 797.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER STONE", "code_information": [{"code": "51050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE FOR GRAFT", "code_information": [{"code": "20900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE FOR GRAFT", "code_information": [{"code": "20902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61514", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1785.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1785.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1785.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1785.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1785.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2041.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2041.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2041.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2041.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2041.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2040.77, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2040.77, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2040.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2040.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2040.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1745.18, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1745.18, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1745.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1745.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1745.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61518", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2597.64, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2597.64, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2597.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2597.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2597.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3574.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3574.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3574.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3574.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3574.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61521", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3008.07, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3008.07, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3008.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3008.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3008.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61524", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1952.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1952.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1952.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1952.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1952.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3249.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3249.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3249.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3249.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3249.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2760.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2760.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2760.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2760.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2760.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61534", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1524.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2441.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2441.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2441.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2441.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2441.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61537", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2180.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2180.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2180.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2180.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2180.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61538", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2326.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2326.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2326.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2326.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2326.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61539", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2211.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2211.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2211.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2211.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2211.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2090.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2090.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2090.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2090.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2090.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61543", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1987.6, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1987.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1987.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1987.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1987.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61566", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2103.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2103.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2103.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2103.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2103.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BREAST LESION", "code_information": [{"code": "19120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18128.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 922.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BREAST TISSUE", "code_information": [{"code": "19300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BROW WRINKLES", "code_information": [{"code": "15826", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CALCIUM DEPOSITS", "code_information": [{"code": "23000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CERVIX", "code_information": [{"code": "57530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CERVIX RADICAL", "code_information": [{"code": "57531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1670.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1670.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1670.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1670.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1670.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CHEST LINING", "code_information": [{"code": "32310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 907.12, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 907.12, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 907.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 907.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 907.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35876", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLLAR BONE", "code_information": [{"code": "23125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1682.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1682.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1682.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1682.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1682.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1131.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1131.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1131.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1131.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1131.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1919.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1919.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1919.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1919.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1919.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1882.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1882.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1882.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1882.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1882.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44156", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2068.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2068.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2068.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2068.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2068.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART", "code_information": [{"code": "33940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART/LUNG", "code_information": [{"code": "33930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR LIVER", "code_information": [{"code": "47133", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIDIDYMIS", "code_information": [{"code": "54860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIDIDYMIS", "code_information": [{"code": "54861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIGLOTTIS", "code_information": [{"code": "31420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2453.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2453.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2453.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2453.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2453.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3835.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3835.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3835.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3835.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3835.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3790.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3790.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3790.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3790.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3790.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43124", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3324.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3324.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3324.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3324.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3324.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 779.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 779.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 779.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 779.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 779.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1375.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1375.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1375.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1375.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1375.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EXTERNAL EAR", "code_information": [{"code": "69120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE", "code_information": [{"code": "65101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE", "code_information": [{"code": "65110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FACE WRINKLES", "code_information": [{"code": "15828", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FALLOPIAN TUBE", "code_information": [{"code": "58700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 747.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 747.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 747.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 747.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 747.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FASCIA FOR GRAFT", "code_information": [{"code": "20920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FASCIA FOR GRAFT", "code_information": [{"code": "20922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FB REACTION", "code_information": [{"code": "D7540", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FINGER LESION", "code_information": [{"code": "26210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FINGER TENDON", "code_information": [{"code": "26180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FASCIA", "code_information": [{"code": "28062", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [{"code": "28190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17917.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 136.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 136.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 136.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 136.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 136.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [{"code": "28192", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [{"code": "28193", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT JOINT LINING", "code_information": [{"code": "28070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT JOINT LINING", "code_information": [{"code": "28072", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT LESION", "code_information": [{"code": "28080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT LESION", "code_information": [{"code": "28090", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT LESION", "code_information": [{"code": "28104", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREARM LESION", "code_information": [{"code": "25120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREHEAD WRINKLES", "code_information": [{"code": "15824", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY", "code_information": [{"code": "20520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 101.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 101.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 101.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 101.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 101.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY", "code_information": [{"code": "20525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY", "code_information": [{"code": "27372", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31084", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31087", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 953.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 953.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 953.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 953.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 953.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 897.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 897.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 897.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 897.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 897.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1144.74, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1144.74, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1144.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1144.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1144.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1153.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1153.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1153.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1153.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1153.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1250.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1250.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1250.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1250.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1250.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GUM TISSUE", "code_information": [{"code": "41830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 201.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 201.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 201.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 201.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 201.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEAD OF HUMERUS", "code_information": [{"code": "23195", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1554.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1554.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1554.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1554.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1554.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1360.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1360.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1360.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1360.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1360.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2461.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2461.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2461.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2461.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2461.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEEL BONE", "code_information": [{"code": "28118", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEEL SPUR", "code_information": [{"code": "28119", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEMORRHOID CLOT", "code_information": [{"code": "46320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP JOINT LINING", "code_information": [{"code": "27054", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27090", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 826.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 826.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 826.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 826.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 826.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27091", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1559.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1559.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1559.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1559.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1559.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23156", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HYDROCELE", "code_information": [{"code": "55040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 26268.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HYDROCELE", "code_information": [{"code": "55500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HYDROCELES", "code_information": [{"code": "55041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPACTED WAX MD", "code_information": [{"code": "G0268", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPLANT DEEP", "code_information": [{"code": "20680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 25560.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPLANT FROM HAND", "code_information": [{"code": "26320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INFUSION PUMP", "code_information": [{"code": "36262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INNER EYE FLUID", "code_information": [{"code": "67036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INNER EYE LESION", "code_information": [{"code": "66770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 213.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 213.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 213.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 213.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 213.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTRANASAL LESION", "code_information": [{"code": "30117", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17320.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTRANASAL LESION", "code_information": [{"code": "30118", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ISCHIAL BURSA", "code_information": [{"code": "27060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF JAW BONE LESION", "code_information": [{"code": "21044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF JAW JOINT", "code_information": [{"code": "21050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY", "code_information": [{"code": "50340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 851.78, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 851.78, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 851.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 851.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 851.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50234", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1344.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1344.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1344.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1344.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1344.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1522.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1522.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1522.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1522.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1522.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 976.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 976.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 976.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 976.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 976.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 915.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 915.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 915.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 915.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 915.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27333", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CYST", "code_information": [{"code": "27345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE PROSTHESIS", "code_information": [{"code": "27488", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1181.91, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1181.91, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1181.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1181.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1181.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEECAP", "code_information": [{"code": "27350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEECAP BURSA", "code_information": [{"code": "27340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1898.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1898.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1898.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1898.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1898.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2371.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2371.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2371.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2371.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2371.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX & PHARYNX", "code_information": [{"code": "31390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2666.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2666.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2666.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2666.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2666.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15890.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 760.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEFT HEART VENT", "code_information": [{"code": "33989", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG ARTERY CLOT", "code_information": [{"code": "34203", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1008.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1008.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1008.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1008.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1008.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG VEINS/LESION", "code_information": [{"code": "37735", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1904.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS LESION", "code_information": [{"code": "66830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL", "code_information": [{"code": "66840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 666.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 666.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 666.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 666.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 666.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL", "code_information": [{"code": "66850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL", "code_information": [{"code": "66852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1282.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG EXTRAPLEURAL", "code_information": [{"code": "32445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3131.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3131.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3131.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3131.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3131.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION", "code_information": [{"code": "32540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1580.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1580.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1580.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1580.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1580.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION(S)", "code_information": [{"code": "32140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 970.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 970.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 970.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 970.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 970.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION(S)", "code_information": [{"code": "32150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 978.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 978.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 978.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 978.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 978.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1227.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1227.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1227.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1227.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1227.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38724", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1326.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1326.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1326.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1326.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1326.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF METATARSAL", "code_information": [{"code": "28140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF METATARSAL HEADS", "code_information": [{"code": "28114", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NAIL BED", "code_information": [{"code": "6900034", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVAL OF NAIL BED", "code_information": [{"code": "6900034", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVAL OF NAIL BED", "code_information": [{"code": "11750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6240.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NAIL PLATE", "code_information": [{"code": "11730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5556.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NECK WRINKLES", "code_information": [{"code": "15825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NERVE LESION", "code_information": [{"code": "64790", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NERVE LESION", "code_information": [{"code": "64792", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE", "code_information": [{"code": "30160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE LESION", "code_information": [{"code": "30124", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18875.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE LESION", "code_information": [{"code": "30125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE POLYP(S)", "code_information": [{"code": "30110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12957.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 131.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 131.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 131.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 131.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 131.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE POLYP(S)", "code_information": [{"code": "30115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OCULAR IMPLANT", "code_information": [{"code": "65175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OMENTUM", "code_information": [{"code": "49255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 725.26, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 725.26, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 725.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 725.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 725.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARIAN CYST(S)", "code_information": [{"code": "58925", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 715.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 715.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 715.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 715.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 715.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY(S)", "code_information": [{"code": "58940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 491.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 491.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 491.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 491.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 491.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY(S)", "code_information": [{"code": "58943", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1093.99, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1093.99, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1093.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1093.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1093.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY/TUBE(S)", "code_information": [{"code": "58720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 704.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 704.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 704.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 704.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 704.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PACEMAKER SYSTEM", "code_information": [{"code": "33234", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PALM TENDON EACH", "code_information": [{"code": "26170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS", "code_information": [{"code": "48155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1640.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1640.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1640.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1640.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1640.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS LESION", "code_information": [{"code": "48120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1004.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1004.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1004.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1004.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1004.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC DUCT", "code_information": [{"code": "48148", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1124.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1124.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1124.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1124.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1124.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC STONE", "code_information": [{"code": "48020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1054.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1054.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1054.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1054.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1054.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PELVIC STRUCTURES", "code_information": [{"code": "51597", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2345.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2345.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2345.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2345.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2345.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PELVIS CONTENTS", "code_information": [{"code": "58240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2611.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2611.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2611.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2611.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2611.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PENIS", "code_information": [{"code": "54125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 841.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 841.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 841.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 841.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 841.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2155.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2155.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2155.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2155.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2155.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1458.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1458.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1458.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1458.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1458.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PM GENERATOR", "code_information": [{"code": "33233", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1122.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1122.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1122.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1122.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1122.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 905.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 905.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 905.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 905.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 905.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 980.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 980.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 980.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 980.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 980.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTAL MARKER", "code_information": [{"code": "46030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 214.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1702.79, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1702.79, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1702.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1702.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1702.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1739.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1739.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1739.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1739.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1739.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1429.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1429.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1429.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1429.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1429.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM AND COLON", "code_information": [{"code": "45121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1571.69, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1571.69, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1571.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1571.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1571.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RESIDUAL CERVIX", "code_information": [{"code": "57540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 763.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 763.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 763.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 763.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 763.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RESIDUAL CERVIX", "code_information": [{"code": "57550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB", "code_information": [{"code": "21615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 668.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 668.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 668.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 668.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 668.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB AND NERVES", "code_information": [{"code": "21616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB(S)", "code_information": [{"code": "32900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1344.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1344.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1344.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1344.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1344.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 120.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 120.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 120.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 120.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 120.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SCROTUM", "code_information": [{"code": "55150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SCROTUM LESION", "code_information": [{"code": "55120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SESAMOID BONE", "code_information": [{"code": "28315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 30815.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SHUNT", "code_information": [{"code": "49429", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SKIN WRINKLES", "code_information": [{"code": "15829", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SKULL LESION", "code_information": [{"code": "61500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1268.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1268.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1268.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1268.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1268.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SLOUGHED OFF BONE", "code_information": [{"code": "D7550", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1102.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1102.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1102.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1102.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1102.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 229.74, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 229.74, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 229.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 229.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 229.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1077.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1077.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1077.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1077.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1077.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPERM CORD LESION", "code_information": [{"code": "55520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPERM DUCT(S)", "code_information": [{"code": "55250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17925.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPINAL SHUNT", "code_information": [{"code": "63746", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN PARTIAL", "code_information": [{"code": "38101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1021.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1021.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1021.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1021.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1021.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 248.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 248.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 248.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 248.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 248.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1803.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1803.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1803.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1803.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1803.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2027.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2027.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2027.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2027.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2027.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2068.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2068.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2068.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2068.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2068.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43631", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1330.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1330.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1330.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1330.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1330.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1755.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1755.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1755.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1755.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1755.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1680.91, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1680.91, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1680.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1680.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1680.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1849.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1849.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1849.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1849.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1849.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 106.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 106.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 106.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 106.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 106.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUTURE FROM ANUS", "code_information": [{"code": "46754", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUTURES", "code_information": [{"code": "S0630", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE", "code_information": [{"code": "27080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TEAR GLAND", "code_information": [{"code": "68500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TEAR SAC", "code_information": [{"code": "68520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TENDON FOR GRAFT", "code_information": [{"code": "20924", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TENDON LESION", "code_information": [{"code": "27630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TESTIS", "code_information": [{"code": "54520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TESTIS", "code_information": [{"code": "54530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 25478.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1000.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1000.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1000.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1000.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1000.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60521", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1143.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1143.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1143.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1143.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1143.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1376.48, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1376.48, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1376.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1376.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1376.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 929.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 929.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 929.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 929.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 929.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1251.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1251.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1251.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1251.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1251.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1312.74, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1312.74, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1312.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1312.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1312.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1013.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1013.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1013.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1013.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1013.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TMJ CONDYLE", "code_information": [{"code": "D7840", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE", "code_information": [{"code": "28150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE LESIONS", "code_information": [{"code": "28092", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE LESIONS", "code_information": [{"code": "28108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONGUE", "code_information": [{"code": "41140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2208.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2208.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2208.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2208.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2208.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONSILS", "code_information": [{"code": "42825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONSILS", "code_information": [{"code": "42826", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14119.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1772.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1772.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1772.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1772.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1772.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1991.56, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1991.56, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1991.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1991.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1991.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER", "code_information": [{"code": "50650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1069.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1069.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1069.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1069.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1069.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER", "code_information": [{"code": "50660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1183.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1183.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1183.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1183.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1183.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 994.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 994.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 994.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 994.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 994.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 938.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 938.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 938.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 938.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 938.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 914.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 914.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 914.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 914.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 914.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "51060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 605.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 605.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 605.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 605.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 605.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA GLAND", "code_information": [{"code": "53250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA GLAND", "code_information": [{"code": "53270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 23828.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA LESION", "code_information": [{"code": "53230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA LESION", "code_information": [{"code": "53235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1453.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1453.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1453.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1453.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1453.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 764.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 764.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 764.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 764.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 764.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1564.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1564.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1564.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1564.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1564.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34471", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 637.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 637.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 637.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 637.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 637.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST BONE", "code_information": [{"code": "25210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST BONES", "code_information": [{"code": "25215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST LESION", "code_information": [{"code": "25130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL PACEMAKER ELECTRODE", "code_information": [{"code": "33235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL PELVIC LYMPH NODES", "code_information": [{"code": "38562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 674.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 674.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 674.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 674.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 674.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL PROSTH RADIAL HEAD", "code_information": [{"code": "24164", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL PULSE GEN ONLY ISDSS", "code_information": [{"code": "682T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL SS DFB ELECTRODE", "code_information": [{"code": "573T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR&STAPL XREQ ANES", "code_information": [{"code": "15854", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR/STAPL XREQ ANES", "code_information": [{"code": "15853", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR/STAPLE REQ ANES", "code_information": [{"code": "15851", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL TUNNELED CV CATH", "code_information": [{"code": "36589", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4869.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL TUNNELED CV CATH", "code_information": [{"code": "36590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5117.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 52.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 52.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 52.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 52.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 52.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE & GRAFT WRIST LESION", "code_information": [{"code": "25135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE & GRAFT WRIST LESION", "code_information": [{"code": "25136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE & TREAT BRAIN LESION", "code_information": [{"code": "61544", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1756.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1756.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1756.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1756.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1756.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMEN LYMPH NODES", "code_information": [{"code": "38780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1028.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1028.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1028.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1028.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1028.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMINAL LYMPH NODES", "code_information": [{"code": "38747", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 253.46, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 253.46, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 253.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 253.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 253.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST 2 STAGE", "code_information": [{"code": "46285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST COMPLEX", "code_information": [{"code": "46280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST INTER", "code_information": [{"code": "46275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST SUBQ", "code_information": [{"code": "46270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANEURYSM SINUS", "code_information": [{"code": "61613", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3022.15, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3022.15, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3022.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3022.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3022.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANKLE JOINT LINING", "code_information": [{"code": "27625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANKLE JOINT LINING", "code_information": [{"code": "27626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1240.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1240.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1240.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1240.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1240.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1351.27, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1351.27, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1351.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1351.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1351.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33851", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1291.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1291.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1291.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1291.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1291.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTIC ASSIST DEVICE", "code_information": [{"code": "33968", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ARMPIT LYMPH NODES", "code_information": [{"code": "38740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ARMPIT LYMPH NODES", "code_information": [{"code": "38745", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BILI DRAIN CATH", "code_information": [{"code": "4917537", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5248.0, "discounted_cash": 3936.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE BLADDER STONE", "code_information": [{"code": "52317", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 16792.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER STONE", "code_information": [{"code": "52318", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 23731.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/CREATE POUCH", "code_information": [{"code": "51596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2424.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2424.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2424.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2424.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2424.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1959.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1959.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1959.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1959.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1959.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1989.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1989.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1989.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1989.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1989.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2257.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2257.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2257.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2257.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2257.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLOOD CLOT FROM EYE", "code_information": [{"code": "65930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CANAL FLUID", "code_information": [{"code": "61050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY FLUID", "code_information": [{"code": "61020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY SHUNT", "code_information": [{"code": "62256", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 544.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 544.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 544.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 544.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 544.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN ELECTRODES", "code_information": [{"code": "61535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 910.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 910.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 910.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 910.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 910.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2413.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2413.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2413.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2413.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2413.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61519", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2793.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2793.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2793.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2793.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2793.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN TUMOR W/SCOPE", "code_information": [{"code": "62164", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1871.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1871.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1871.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1871.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1871.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CADAVER DONOR KIDNEY", "code_information": [{"code": "50300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1374.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1374.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1374.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1374.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1374.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1724.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1724.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1724.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1724.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1724.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CARTILAGE FOR GRAFT", "code_information": [{"code": "20910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CARTILAGE FOR GRAFT", "code_information": [{"code": "20912", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CERCLAGE SUTURE", "code_information": [{"code": "59871", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX REPAIR BOWEL", "code_information": [{"code": "57556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR PELVIS", "code_information": [{"code": "57545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 808.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 808.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 808.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 808.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 808.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR VAGINA", "code_information": [{"code": "57555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 595.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 595.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 595.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 595.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 595.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLOID CYST W/SCOPE", "code_information": [{"code": "62162", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1766.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1766.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1766.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1766.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1766.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CONTRACEPTIVE CAPSULE", "code_information": [{"code": "11976", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CORONOID PROCESS", "code_information": [{"code": "21070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA DEVICE OBSTRUCT", "code_information": [{"code": "75901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 344.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 344.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 171.55, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 171.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 171.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 171.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 171.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE DIGIT NERVE LESION", "code_information": [{"code": "64776", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE DRUG IMPLANT", "code_information": [{"code": "G0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE DRUG IMPLANT DEVICE", "code_information": [{"code": "11982", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 11710.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR CANAL LESION(S)", "code_information": [{"code": "69140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR CANAL LESION(S)", "code_information": [{"code": "69145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 33590.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2557.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2557.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2557.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2557.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2557.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ELCTRD TRANSVENOUSLY", "code_information": [{"code": "33244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 924.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 924.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 924.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 924.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 924.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 800.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 800.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 800.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 800.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 800.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33237", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 880.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 880.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 880.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 880.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 880.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 956.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 956.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 956.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 956.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 956.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ELTRD/THORACOTOMY", "code_information": [{"code": "33243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1378.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1378.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1378.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1378.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1378.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EPIDIDYMIS LESION", "code_information": [{"code": "54830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EPIDIDYMIS LESION", "code_information": [{"code": "54840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 24098.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ESOPHAGUS OBSTRUCTION", "code_information": [{"code": "74235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EXOSTOSIS MANDIBLE", "code_information": [{"code": "21031", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 203.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 203.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 203.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 203.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 203.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXOSTOSIS MAXILLA", "code_information": [{"code": "21032", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 209.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 209.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 209.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 209.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 209.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXT HEM GROUPS 2+", "code_information": [{"code": "46250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTERNAL EAR PARTIAL", "code_information": [{"code": "69110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTRA SPINE SEGMENT", "code_information": [{"code": "22103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2090.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2090.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2090.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2090.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2090.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTRA SPINE SEGMENT", "code_information": [{"code": "22116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 141.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 141.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 141.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 141.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 141.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE IMPLANT MATERIAL", "code_information": [{"code": "67120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE IMPLANT MATERIAL", "code_information": [{"code": "67121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE LESION", "code_information": [{"code": "65900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE LESION", "code_information": [{"code": "66130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/ATTACH IMPLANT", "code_information": [{"code": "65105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/INSERT IMPLANT", "code_information": [{"code": "65103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/REVISE SOCKET", "code_information": [{"code": "65112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/REVISE SOCKET", "code_information": [{"code": "65114", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID FOREIGN BODY", "code_information": [{"code": "67938", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESION", "code_information": [{"code": "67800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESION", "code_information": [{"code": "67840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 172.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 172.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 172.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 172.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 172.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESION(S)", "code_information": [{"code": "67808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESIONS", "code_information": [{"code": "67801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14066.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 66.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESIONS", "code_information": [{"code": "67805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 86.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 86.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 86.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 86.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 86.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 20574.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 131.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 131.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 131.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 131.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 131.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FB SUBQ SIMPLE", "code_information": [{"code": "6900120", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE FB SUBQ SIMPLE", "code_information": [{"code": "6900120", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1879.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION", "code_information": [{"code": "27355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/BURSA", "code_information": [{"code": "27062", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 16620.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/FIXATION", "code_information": [{"code": "27358", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/GRAFT", "code_information": [{"code": "27356", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/GRAFT", "code_information": [{"code": "27357", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FINGER BONE", "code_information": [{"code": "26185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREARM BONE LESION", "code_information": [{"code": "25145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREARM FOREIGN BODY", "code_information": [{"code": "25248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY ADBOMEN", "code_information": [{"code": "49402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY BRAIN", "code_information": [{"code": "61570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1719.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1719.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1719.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1719.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1719.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY LARYNX", "code_information": [{"code": "31511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 72.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE GASTRIC PORT OPEN", "code_information": [{"code": "43887", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 26018.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE GROIN LYMPH NODES", "code_information": [{"code": "38760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE GROIN LYMPH NODES", "code_information": [{"code": "38765", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1212.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1212.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1212.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1212.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1212.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HAND BONE LESION", "code_information": [{"code": "26200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP BONE LES DEEP", "code_information": [{"code": "27066", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP BONE LES SUPER", "code_information": [{"code": "27065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP FOREIGN BODY", "code_information": [{"code": "27086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP FOREIGN BODY", "code_information": [{"code": "27087", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15941", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15944", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15945", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15946", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HUMERUS LESION", "code_information": [{"code": "23174", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HUMERUS LESION", "code_information": [{"code": "23184", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPACTED EAR WAX UNI", "code_information": [{"code": "69209", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPACTED EAR WAX UNI", "code_information": [{"code": "69210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPLANT BODY", "code_information": [{"code": "D6105", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 428.21, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 385.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 374.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 428.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 428.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 428.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPLANT OF EYE", "code_information": [{"code": "65920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GROUPS 2+", "code_information": [{"code": "46260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18859.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRP & FISS", "code_information": [{"code": "46257", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRP W/FISTU", "code_information": [{"code": "46258", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRPS & FISS", "code_information": [{"code": "46261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRPS W/FIST", "code_information": [{"code": "46262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INFECTED SKULL BONE", "code_information": [{"code": "61501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1079.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1079.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1079.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1079.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1079.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR", "code_information": [{"code": "69905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR & MASTOID", "code_information": [{"code": "69910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR LESION", "code_information": [{"code": "69970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2157.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2157.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2157.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2157.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2157.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INT/EXT HEM 1 GROUP", "code_information": [{"code": "46255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 21860.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTERIM IMPLANT", "code_information": [{"code": "D6198", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTESTINAL ALLOGRAFT", "code_information": [{"code": "44137", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRA-AORTIC BALLOON", "code_information": [{"code": "33974", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 921.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 921.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 921.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 921.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 921.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRACORPOREAL DEVICE", "code_information": [{"code": "33980", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3584.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3584.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3584.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3584.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3584.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRAUTERINE DEVICE", "code_information": [{"code": "58301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10049.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 43.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRVAS FOREIGN BODY", "code_information": [{"code": "37197", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IRIS AND LESION", "code_information": [{"code": "66600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE JAW JOINT CARTILAGE", "code_information": [{"code": "21060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY LIVING DONOR", "code_information": [{"code": "50320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1359.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1359.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1359.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1359.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1359.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY OPEN", "code_information": [{"code": "50220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1058.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1058.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1058.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1058.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1058.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE CYST", "code_information": [{"code": "27347", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27334", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LAMINA/FACETS LUMBAR", "code_information": [{"code": "63012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1133.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1133.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1133.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1133.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1133.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LIMB NERVE LESION", "code_information": [{"code": "64782", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LOWER LEG BONE LESION", "code_information": [{"code": "27635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUMB ARTIF DISC ADDL", "code_information": [{"code": "164T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1645.46, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1645.46, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1645.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1645.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1645.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1322.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1322.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1322.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1322.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1322.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG CATHETER", "code_information": [{"code": "32552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6888.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG FOREIGN BODY", "code_information": [{"code": "32151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1001.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1001.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1001.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1001.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1001.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG PNEUMONECTOMY", "code_information": [{"code": "32440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1586.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1586.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1586.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1586.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1586.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MANDIBLE CYST COMPLEX", "code_information": [{"code": "21046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID AIR CELLS", "code_information": [{"code": "69670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID STRUCTURES", "code_information": [{"code": "69505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MAXILLA CYST COMPLEX", "code_information": [{"code": "21048", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MIDDLE EAR NERVE", "code_information": [{"code": "69676", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MUTI-COMP PENIS PROS", "code_information": [{"code": "54406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 33590.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NAIL PLATE ADD-ON", "code_information": [{"code": "6900032", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 904.0, "discounted_cash": 678.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE NAIL PLATE ADD-ON", "code_information": [{"code": "6900032", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 904.0, "discounted_cash": 678.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE NAIL PLATE ADD-ON", "code_information": [{"code": "11732", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NERVE LESION", "code_information": [{"code": "64784", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NON-RESORB BARRIER", "code_information": [{"code": "D4286", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PALATE/LESION", "code_information": [{"code": "42120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART LUMBAR VERTEBRA", "code_information": [{"code": "22102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2090.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2090.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2090.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2090.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2090.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART LUMBAR VERTEBRA", "code_information": [{"code": "22114", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 973.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 973.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 973.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 973.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 973.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF NECK VERTEBRA", "code_information": [{"code": "22100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 795.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 795.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 795.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 795.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 795.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF NECK VERTEBRA", "code_information": [{"code": "22110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 975.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 975.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 975.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 975.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 975.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF TEMPORAL BONE", "code_information": [{"code": "69535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 140.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 140.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 140.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 140.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 140.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 794.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 794.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 794.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 794.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 794.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 971.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 971.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 971.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 971.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 971.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PELVIS LYMPH NODES", "code_information": [{"code": "38770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.04, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.04, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1239.4, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1239.4, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1239.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1239.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1239.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1570.8, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1570.8, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1570.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1570.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1570.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PERC LEFT HEART VAD", "code_information": [{"code": "4613992", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3478.0, "discounted_cash": 2608.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE PHARYNX FOREIGN BODY", "code_information": [{"code": "42809", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST COMPL", "code_information": [{"code": "11772", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST EXTEN", "code_information": [{"code": "11771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 30844.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST SIMPLE", "code_information": [{"code": "11770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 22422.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PITUIT TUMOR W/SCOPE", "code_information": [{"code": "62165", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1457.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1457.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1457.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1457.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1457.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PROSTATE REGROWTH", "code_information": [{"code": "52630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PULMONARY SHUNT", "code_information": [{"code": "33924", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 291.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 291.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 291.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 291.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 291.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PULSE GENERATOR", "code_information": [{"code": "33241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTAL OBSTRUCTION", "code_information": [{"code": "45915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTUM W/RESERVOIR", "code_information": [{"code": "45119", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1791.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1791.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1791.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1791.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1791.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE RENAL TUBE W/FLUORO", "code_information": [{"code": "50389", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4881.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15931", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15933", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15934", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15935", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15936", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15937", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SCIATIC NERVE LESION", "code_information": [{"code": "64786", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SCREW RETAINED PLATE", "code_information": [{"code": "D7298", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SELF-CONTD PENIS PROS", "code_information": [{"code": "54415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 27830.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23172", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23182", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BONE PART", "code_information": [{"code": "23130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FB DEEP", "code_information": [{"code": "23333", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FOREIGN BODY", "code_information": [{"code": "23330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER JOINT LINING", "code_information": [{"code": "23105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SINGLE NAIL PLATE", "code_information": [{"code": "6900033", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE SINGLE NAIL PLATE", "code_information": [{"code": "6900033", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE SKIN NERVE LESION", "code_information": [{"code": "64774", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SKIN NERVE LESION", "code_information": [{"code": "64788", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPERM DUCT POUCH", "code_information": [{"code": "55650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 746.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 746.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 746.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 746.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 746.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPERM POUCH LESION", "code_information": [{"code": "55680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINAL CANAL CATHETER", "code_information": [{"code": "62355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINAL CORD LESION", "code_information": [{"code": "63600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE ELTRD PERQ ARAY", "code_information": [{"code": "63661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE ELTRD PLATE", "code_information": [{"code": "63662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "estimated_discounted_cash": 24457.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE FIXATION DEVICE", "code_information": [{"code": "22850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 702.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 702.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 702.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 702.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 702.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE FIXATION DEVICE", "code_information": [{"code": "22852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE INFUSION DEVICE", "code_information": [{"code": "62365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 CRVL", "code_information": [{"code": "63001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 LMBR", "code_information": [{"code": "63005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "estimated_discounted_cash": 36785.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1110.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1110.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1110.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1110.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1110.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 SCRL", "code_information": [{"code": "63011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1037.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1037.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1037.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1037.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1037.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 THRC", "code_information": [{"code": "63003", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1165.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1165.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1165.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1165.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1165.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA >2 CRVCL", "code_information": [{"code": "63015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1395.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1395.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1395.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1395.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1395.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA >2 LMBR", "code_information": [{"code": "63017", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA >2 THRC", "code_information": [{"code": "63016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1424.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1424.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1424.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1424.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1424.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE STENT VIA TRANSURETH", "code_information": [{"code": "50386", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64804", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 905.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 905.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 905.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 905.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 905.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64809", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 838.37, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 838.37, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 838.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 838.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 838.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64818", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 644.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 644.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 644.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 644.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 644.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TEAR GLAND LESION", "code_information": [{"code": "68540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TEAR GLAND LESION", "code_information": [{"code": "68550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TENDON SHEATH LESION", "code_information": [{"code": "26160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15952", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15953", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15956", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 118.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15958", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 55.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THORACIC LYMPH NODES", "code_information": [{"code": "38746", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 257.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 257.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 257.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 257.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 257.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID DUCT LESION", "code_information": [{"code": "60280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID DUCT LESION", "code_information": [{"code": "60281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID LESION", "code_information": [{"code": "60200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1980.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TONSILS AND ADENOIDS", "code_information": [{"code": "42820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15677.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TONSILS AND ADENOIDS", "code_information": [{"code": "42821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 15559.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TRANSPLANTED KIDNEY", "code_information": [{"code": "50370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1064.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1064.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1064.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1064.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1064.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TUNNELED IP CATH", "code_information": [{"code": "49422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER CALCULUS", "code_information": [{"code": "51065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER STENT PERC", "code_information": [{"code": "4917528", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12138.0, "discounted_cash": 9103.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE URETER STENT PERCUT", "code_information": [{"code": "50384", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE URO SPHINCTER", "code_information": [{"code": "53446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS AFTER CESAREAN", "code_information": [{"code": "59525", "type": "CPT"}], "standard_charges": [{"minimum": 477.65, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 477.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 477.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 477.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 477.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 477.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS LESION", "code_information": [{"code": "59100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA GLAND LESION", "code_information": [{"code": "56740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA LESION", "code_information": [{"code": "57130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA LESION", "code_information": [{"code": "57135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE COMPL", "code_information": [{"code": "57111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1590.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1590.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1590.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1590.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1590.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE PART", "code_information": [{"code": "57107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1364.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1364.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1364.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1364.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1364.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL COMPLETE", "code_information": [{"code": "57110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 887.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 887.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 887.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 887.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 887.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL PARTIAL", "code_information": [{"code": "57106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 27830.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 467.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 467.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 467.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 467.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 467.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINAL FOREIGN BODY", "code_information": [{"code": "57415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGUS N ELTRD", "code_information": [{"code": "64570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION SCOPE/GRAFT", "code_information": [{"code": "31546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION W/SCOPE", "code_information": [{"code": "31545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1015.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTILATING TUBE", "code_information": [{"code": "69424", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12455.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33977", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1241.27, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1241.27, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1241.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1241.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1241.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33978", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1378.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1378.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1378.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1378.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1378.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN CRVL", "code_information": [{"code": "63081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1693.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1693.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1693.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1693.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1693.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN LMBR", "code_information": [{"code": "63090", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1877.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1877.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1877.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1877.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1877.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN LMBR", "code_information": [{"code": "63102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2160.56, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2160.56, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2160.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2160.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2160.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN THRC", "code_information": [{"code": "63085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1804.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1804.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1804.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1804.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1804.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN THRC", "code_information": [{"code": "63101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2165.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2165.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2165.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2165.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2165.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT IDRL BODY CRVCL", "code_information": [{"code": "63304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2145.63, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2145.63, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2145.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2145.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2145.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT IDRL BODY THRC", "code_information": [{"code": "63305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2210.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2210.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2210.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2210.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2210.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY CRVCL", "code_information": [{"code": "63300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1736.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1736.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1736.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1736.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1736.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY THRC", "code_information": [{"code": "63301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1919.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1919.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1919.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1919.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1919.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY THRLMB", "code_information": [{"code": "63302", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1906.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1906.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1906.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1906.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1906.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63082", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 268.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 268.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 268.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 268.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 268.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 190.12, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 190.12, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 190.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 190.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 190.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63088", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 258.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 258.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 258.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 258.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 258.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63091", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 177.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 177.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 177.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 177.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 177.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 282.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 282.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 282.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 282.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 282.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 322.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 322.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 322.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 322.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 322.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE W INSERT DRUG IMPLANT", "code_information": [{"code": "G0518", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1083.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1083.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1083.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1083.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1083.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31786", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT CARTILAGE", "code_information": [{"code": "25107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT IMPLANT", "code_information": [{"code": "25449", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT LINING", "code_information": [{"code": "25105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT LINING", "code_information": [{"code": "26130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST TENDON LESION", "code_information": [{"code": "25110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST TENDON LESION", "code_information": [{"code": "25111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST/FOREARM LESION", "code_information": [{"code": "25115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST/FOREARM LESION", "code_information": [{"code": "25116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE&REPLACE PM GEN SINGL", "code_information": [{"code": "33227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "estimated_discounted_cash": 26130.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT BONE LESION", "code_information": [{"code": "26205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FINGER LESION", "code_information": [{"code": "26215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOREARM LESION", "code_information": [{"code": "25125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOREARM LESION", "code_information": [{"code": "25126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT HIP BONE LESION", "code_information": [{"code": "27067", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT LEG BONE LESION", "code_information": [{"code": "27637", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT LEG BONE LESION", "code_information": [{"code": "27638", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/INSERT DRUG IMPLANT", "code_information": [{"code": "11983", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPAIR HEARING AID", "code_information": [{"code": "69711", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPLACE PENIS PROSTH", "code_information": [{"code": "54410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPLACE UR SPHINCTER", "code_information": [{"code": "53447", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/REVISE MALE SLING", "code_information": [{"code": "53442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/TRANSPLANT TENDON", "code_information": [{"code": "23440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/TREAT LUNG LESIONS", "code_information": [{"code": "32141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1393.8, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1393.8, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1393.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1393.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1393.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMV TUNL CVC WO PMP/PRT", "code_information": [{"code": "4916589", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6621.0, "discounted_cash": 4965.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REMV TUNL CVC WO PMP/PRT", "code_information": [{"code": "6296589", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1279.0, "discounted_cash": 959.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN DUAL LEAD", "code_information": [{"code": "33228", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "estimated_discounted_cash": 29152.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN MULT LEADS", "code_information": [{"code": "33229", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "estimated_discounted_cash": 54234.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMV/REPL PENIS CONTAIN PROS", "code_information": [{"code": "54416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8643.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMV/REPLC PENIS PROS COMPL", "code_information": [{"code": "54417", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 925.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 925.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 925.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 925.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 925.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMVE RENL TUBE W/FLUORO", "code_information": [{"code": "4914238", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5782.0, "discounted_cash": 4336.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REMVL INSJ IMPLTBL GLUC SENS", "code_information": [{"code": "448T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL ABSCESS OPEN DRAIN", "code_information": [{"code": "50020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1024.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1024.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1024.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1024.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1024.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL BIOPSY PERQ", "code_information": [{"code": "50200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4742.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 417.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL BX SURG EXPOSURE KDN", "code_information": [{"code": "50205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 697.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 697.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 697.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 697.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 697.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITH CC", "code_information": [{"code": "683", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29078.31, "maximum": 36642.6, "estimated_discounted_cash": 61646.7, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29078.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36642.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITH MCC", "code_information": [{"code": "682", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49172.16, "maximum": 61963.56, "estimated_discounted_cash": 81726.11, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49172.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61963.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITHOUT CC/MCC", "code_information": [{"code": "684", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19931.16, "maximum": 25115.95, "estimated_discounted_cash": 43877.27, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19931.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25115.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL FUNCTION PANEL", "code_information": [{"code": "80069", "type": "CPT"}, {"code": "4100069", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 44.27, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 44.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.13, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL SCOPE W/TUMOR RESECT", "code_information": [{"code": "50562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENIN", "code_information": [{"code": "84244", "type": "CPT"}, {"code": "7258424", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 112.16, "gross_charge": 386.0, "discounted_cash": 289.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 112.16, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 672.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 672.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 184.38, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 184.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 184.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 184.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 184.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 209.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 209.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80417", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 224.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 224.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.46, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 61.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 61.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 61.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 61.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REOP REQ BLD GRFT OTH", "code_information": [{"code": "G8577", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REOPEN FALLOPIAN TUBE", "code_information": [{"code": "58345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REOPEN FALLOPIAN TUBE", "code_information": [{"code": "58350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REOPENING OF ABDOMEN", "code_information": [{"code": "49002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 902.64, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 902.64, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 902.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 902.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 902.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REOPERATION BYPASS GRAFT", "code_information": [{"code": "35700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 159.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 159.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 159.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 159.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 159.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REOPERATION CAROTID ADD-ON", "code_information": [{"code": "35390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 165.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 165.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 165.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 165.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 165.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP NPH/URT CATH W/DIL STRIC", "code_information": [{"code": "C7546", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER FISTU", "code_information": [{"code": "46715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 453.48, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 453.48, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 453.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 453.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 453.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER/VESTIB FISTU", "code_information": [{"code": "46716", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1037.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1037.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1037.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1037.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1037.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAGLINIDE 0.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310552", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAGLINIDE 0.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310552", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR & REVISE NERVE ADD-ON", "code_information": [{"code": "64874", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ACHILLES TENDON", "code_information": [{"code": "27650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ANAL FISTULA", "code_information": [{"code": "46288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ANOMALY W/CONDUIT", "code_information": [{"code": "33608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1846.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1846.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1846.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1846.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1846.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ANORECTAL FIST W/PLUG", "code_information": [{"code": "46707", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARM/LEG NERVE", "code_information": [{"code": "64857", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ART INTRAMURAL", "code_information": [{"code": "33507", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1761.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1761.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1761.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1761.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1761.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERIAL TRUNK", "code_information": [{"code": "33786", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2305.58, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2305.58, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2305.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2305.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2305.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35082", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2240.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2240.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2240.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2240.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2240.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35092", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2666.78, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2666.78, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2666.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2666.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2666.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2313.44, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2313.44, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2313.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2313.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2313.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE ARM", "code_information": [{"code": "35013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1282.99, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1282.99, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1282.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1282.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1282.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE BELLY", "code_information": [{"code": "35122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2014.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2014.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2014.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2014.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2014.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE CHEST", "code_information": [{"code": "35022", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1440.17, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1440.17, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1440.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1440.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1440.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE GROIN", "code_information": [{"code": "35132", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1758.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1758.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1758.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1758.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1758.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE NECK", "code_information": [{"code": "35002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1241.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1241.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1241.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1241.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1241.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE SPLEEN", "code_information": [{"code": "35112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1737.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1737.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1737.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1737.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1737.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE THIGH", "code_information": [{"code": "35142", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1383.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1383.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1383.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1383.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1383.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY TRANSLOCATION", "code_information": [{"code": "33506", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2058.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2058.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2058.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2058.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2058.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY W/TUNNEL", "code_information": [{"code": "33505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2020.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2020.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2020.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2020.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2020.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BICEPS TENDON", "code_information": [{"code": "23430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 20947.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER & VAGINA", "code_information": [{"code": "57289", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER DEFECT", "code_information": [{"code": "57288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 18411.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER NECK", "code_information": [{"code": "51845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 611.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 611.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 611.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 611.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 611.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER-VAGINA LESION", "code_information": [{"code": "57320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER-VAGINA LESION", "code_information": [{"code": "57330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 776.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 776.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 776.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 776.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 776.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER/VAGINA LESION", "code_information": [{"code": "51900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 853.78, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 853.78, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 853.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 853.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 853.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 846.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 846.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 846.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 846.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 846.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35182", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1752.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1752.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1752.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1752.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1752.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35184", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1055.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1055.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1055.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1055.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1055.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35188", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35189", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1660.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1660.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1660.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1660.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1660.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 778.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 778.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 778.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 778.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 778.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 974.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 974.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 974.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 974.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 974.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 798.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 798.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 798.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 798.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 798.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35207", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35211", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1400.53, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1400.53, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1400.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1400.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1400.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1843.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1843.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1843.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1843.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1843.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1427.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1427.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1427.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1427.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1427.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 884.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 884.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 884.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 884.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 884.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1209.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1209.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1209.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1209.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1209.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1011.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1011.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1011.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1011.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1011.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1463.44, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1463.44, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1463.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1463.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1463.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1572.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1572.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1572.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1572.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1572.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1699.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1699.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1699.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1699.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1699.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35256", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1065.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1065.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1065.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1065.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1065.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1068.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1068.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1068.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1068.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1068.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 887.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 887.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 887.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 887.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 887.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1396.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1396.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1396.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1396.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1396.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1466.07, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1466.07, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1466.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1466.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1466.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1624.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1624.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1624.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1624.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1624.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 983.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 983.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 983.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 983.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 983.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL FISTULA", "code_information": [{"code": "44650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1338.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1338.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1338.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1338.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1338.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 784.69, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 784.69, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 784.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 784.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 784.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 929.77, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 929.77, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 929.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 929.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 929.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1478.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1478.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1478.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1478.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1478.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1294.33, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1294.33, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1294.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1294.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1294.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1451.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1451.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1451.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1451.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1451.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-SKIN FISTULA", "code_information": [{"code": "44640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1288.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1288.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1288.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1288.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1288.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BRAIN FLUID LEAKAGE", "code_information": [{"code": "62100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BRONCHUS ADD-ON", "code_information": [{"code": "32501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 245.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 245.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 245.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 245.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 245.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BROW DEFECT", "code_information": [{"code": "67900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BY ENLARGEMENT", "code_information": [{"code": "33610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1828.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1828.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1828.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1828.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1828.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CARPAL BONE SHORTEN", "code_information": [{"code": "25394", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLITORIS", "code_information": [{"code": "56805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CORPOREAL TEAR", "code_information": [{"code": "54437", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CV CATH WO SQ PMP", "code_information": [{"code": "4916575", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8241.0, "discounted_cash": 6180.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR CVAD W SQ PUMP", "code_information": [{"code": "4916577", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8241.0, "discounted_cash": 6180.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARM ARTERY", "code_information": [{"code": "35045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1003.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1003.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1003.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1003.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1003.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1188.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1188.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1188.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1188.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1188.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1036.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1036.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1036.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1036.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1036.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35021", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1251.74, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1251.74, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1251.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1251.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1251.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1770.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1770.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1770.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1770.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1770.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35091", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1903.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1903.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1903.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1903.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1903.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.58, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.58, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1434.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1434.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1434.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1434.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1434.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1715.46, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1715.46, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1715.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1715.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1715.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35131", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1457.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1457.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1457.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1457.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1457.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1163.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1163.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1163.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1163.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1163.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1309.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1309.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1309.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1309.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1309.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFORMITY OF TOE", "code_information": [{"code": "28313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEGENERATED KNEECAP", "code_information": [{"code": "27418", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 351.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 351.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 351.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 351.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 351.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA CRTX", "code_information": [{"code": "67101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 323.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 323.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 323.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 323.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 323.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA PC", "code_information": [{"code": "67105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DIAPHRAGM LACERATION", "code_information": [{"code": "39501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 810.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 810.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 810.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 810.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 810.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DISLOCATED JAW", "code_information": [{"code": "21490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1953.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1953.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1953.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1953.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1953.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2083.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2083.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2083.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2083.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2083.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DURA", "code_information": [{"code": "61618", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1226.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1226.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1226.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1226.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1226.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DURA", "code_information": [{"code": "61619", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1420.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1420.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1420.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1420.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1420.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EARDRUM STRUCTURES", "code_information": [{"code": "69631", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 18392.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EARDRUM STRUCTURES", "code_information": [{"code": "69635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW DEB/ATTCH OPEN", "code_information": [{"code": "24359", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW PERC", "code_information": [{"code": "24357", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW W/DEB OPEN", "code_information": [{"code": "24358", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1098.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1098.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1098.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1098.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1098.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1628.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1628.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1628.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1628.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1628.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 953.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 953.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 953.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 953.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 953.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1411.74, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1411.74, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1411.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1411.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1411.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS WOUND", "code_information": [{"code": "43410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 959.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 959.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 959.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 959.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 959.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS WOUND", "code_information": [{"code": "43415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1628.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1628.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1628.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1628.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1628.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTRA TOE(S)", "code_information": [{"code": "28344", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67903", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67906", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67908", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67914", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 189.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 189.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 189.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 189.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 189.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67916", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67917", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67921", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 184.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 184.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 184.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 184.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 184.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67923", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67924", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID WOUND", "code_information": [{"code": "67930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 185.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 185.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 185.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 185.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 185.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID WOUND", "code_information": [{"code": "67935", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69745", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FIBULA NONUNION", "code_information": [{"code": "27726", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER DEFORMITY", "code_information": [{"code": "26590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26418", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26432", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26433", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26356", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26357", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26373", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FISTULA W/COLOSTOMY", "code_information": [{"code": "45805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1300.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1300.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1300.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1300.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1300.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FISTULA W/COLOSTOMY", "code_information": [{"code": "45825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1333.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1333.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1333.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1333.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1333.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON SHEATH", "code_information": [{"code": "25275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25274", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2116.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2116.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2116.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2116.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2116.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2142.18, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2142.18, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2142.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2142.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2142.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33774", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1839.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1839.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1839.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1839.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1839.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33775", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1848.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1848.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1848.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1848.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1848.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33776", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1931.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1931.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1931.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1931.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1931.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33777", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1911.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1911.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1911.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1911.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1911.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33778", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2373.79, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2373.79, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2373.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2373.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2373.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33779", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2201.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2201.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2201.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2201.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2201.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2349.46, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2349.46, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2349.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2349.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2349.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2215.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2215.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2215.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2215.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2215.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GUM", "code_information": [{"code": "41872", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 203.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 203.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 203.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 203.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 203.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND DEFORMITY", "code_information": [{"code": "26580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT", "code_information": [{"code": "26540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT WITH GRAFT", "code_information": [{"code": "26541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT WITH GRAFT", "code_information": [{"code": "26542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND TENDON", "code_information": [{"code": "26410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1575.37, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1575.37, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1575.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1575.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1575.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33681", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1866.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1866.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1866.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1866.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1866.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33684", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1891.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1891.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1891.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1891.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1891.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33688", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1834.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1834.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1834.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1834.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1834.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECTS", "code_information": [{"code": "33647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1712.17, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1712.17, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1712.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1712.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1712.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART VESSEL FISTULA", "code_information": [{"code": "33500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1583.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1583.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1583.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1583.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1583.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART VESSEL FISTULA", "code_information": [{"code": "33501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1095.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1095.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1095.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1095.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1095.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART-VEIN DEFECT", "code_information": [{"code": "33732", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1693.37, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1693.37, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1693.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1693.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1693.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART-VEIN DEFECT(S)", "code_information": [{"code": "33730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2001.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2001.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2001.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2001.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2001.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HUMERUS WITH GRAFT", "code_information": [{"code": "24435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ING HERNIA SLIDING", "code_information": [{"code": "49525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR IRIS & CILIARY BODY", "code_information": [{"code": "66680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR IRIS & CILIARY BODY", "code_information": [{"code": "66682", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LAC PALATE<2 CM", "code_information": [{"code": "42180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LAMINECTOMY DEFECT", "code_information": [{"code": "63295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 304.48, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 304.48, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 304.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 304.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 304.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LEAD PACE-DEFIB DUAL", "code_information": [{"code": "33220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LEAD PACE-DEFIB ONE", "code_information": [{"code": "33218", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "estimated_discounted_cash": 116969.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LEG FASCIA DEFECT", "code_information": [{"code": "27656", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1247.04, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1247.04, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1247.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1247.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1247.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1691.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1691.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1691.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1691.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1691.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2794.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2794.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2794.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2794.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2794.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47362", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1289.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1289.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1289.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1289.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1289.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG EPIPHYSES", "code_information": [{"code": "27734", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG TENDONS", "code_information": [{"code": "27675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG TENDONS", "code_information": [{"code": "27676", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LUMBAR HERNIA", "code_information": [{"code": "49540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LUNG HERNIA", "code_information": [{"code": "32800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 921.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 921.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 921.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 921.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 921.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1065.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1065.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1065.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1065.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1065.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1373.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1373.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1373.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1373.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1373.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR VESSEL", "code_information": [{"code": "33321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1212.27, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1212.27, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1212.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1212.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1212.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MAXILLOFACIAL DEFECTS", "code_information": [{"code": "D7955", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MIDDLE EAR STRUCTURES", "code_information": [{"code": "69666", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MIDDLE EAR STRUCTURES", "code_information": [{"code": "69667", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MODIFIED FONTAN", "code_information": [{"code": "33615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1970.91, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1970.91, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1970.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1970.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1970.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH LACERATION", "code_information": [{"code": "40830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH LACERATION", "code_information": [{"code": "40831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH/NOSE FISTULA", "code_information": [{"code": "30600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MULTI-COMP PENIS PROS", "code_information": [{"code": "54408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MUSCLES OF HAND", "code_information": [{"code": "26591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL SEPTUM DEFECT", "code_information": [{"code": "30630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL STENOSIS", "code_information": [{"code": "30465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE ADD-ON", "code_information": [{"code": "64832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE ADD-ON", "code_information": [{"code": "64837", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE/SHORTEN BONE", "code_information": [{"code": "64876", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION CARPAL BONE", "code_information": [{"code": "25431", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION HAND", "code_information": [{"code": "26546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NOSE TO LIP FISTULA", "code_information": [{"code": "42260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ABDOMINAL WALL", "code_information": [{"code": "49900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 755.29, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 755.29, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 755.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 755.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 755.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ACHILLES TENDON", "code_information": [{"code": "27654", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46751", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 582.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 582.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 582.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 582.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 582.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL STRICTURE", "code_information": [{"code": "46700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL STRICTURE", "code_information": [{"code": "46705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 455.33, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 455.33, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 455.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 455.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 455.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENT", "code_information": [{"code": "27695", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENT", "code_information": [{"code": "27698", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENTS", "code_information": [{"code": "27696", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10342.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF AORTIC VALVE", "code_information": [{"code": "33414", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2132.53, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2132.53, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2132.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2132.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2132.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF AORTIC VALVE", "code_information": [{"code": "33417", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1701.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1701.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1701.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1701.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1701.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ARM NERVES", "code_information": [{"code": "64861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER OPENING", "code_information": [{"code": "51880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER WOUND", "code_information": [{"code": "51860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 748.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 748.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 748.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 748.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 748.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER WOUND", "code_information": [{"code": "51865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 917.79, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 917.79, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 917.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 917.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 917.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BODY CAST", "code_information": [{"code": "29720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 42.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 42.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 42.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 42.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 42.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL BULGE", "code_information": [{"code": "57268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL LESION", "code_information": [{"code": "44605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1199.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1199.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1199.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1199.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1199.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL POUCH", "code_information": [{"code": "57270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 783.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 783.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 783.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 783.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 783.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CIRCUMCISION", "code_information": [{"code": "54163", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46744", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3091.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3091.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3091.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3091.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3091.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46746", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3479.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3479.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3479.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3479.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3479.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46748", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3550.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3550.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3550.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3550.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3550.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39503", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5438.71, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5438.71, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5438.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5438.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5438.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 823.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 823.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 823.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 823.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 823.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 884.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 884.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 884.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 884.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 884.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIGIT NERVE", "code_information": [{"code": "64831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EARDRUM", "code_information": [{"code": "69610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 192.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 192.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 192.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 192.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 192.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EARDRUM", "code_information": [{"code": "69620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 619.6, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 619.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 619.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 619.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 619.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1482.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1482.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1482.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1482.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1482.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE SOCKET WOUND", "code_information": [{"code": "65290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 338.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 338.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 338.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 338.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 338.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 228.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64864", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FIBULA EPIPHYSIS", "code_information": [{"code": "27732", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT BONES", "code_information": [{"code": "28320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT TENDON", "code_information": [{"code": "28200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 13256.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT TENDON", "code_information": [{"code": "28208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAMMERTOE", "code_information": [{"code": "28285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14299.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAMMERTOE", "code_information": [{"code": "28286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64834", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART CHAMBERS", "code_information": [{"code": "33670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2051.6, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2051.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2051.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2051.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2051.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DAMAGE", "code_information": [{"code": "33545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2923.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2923.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2923.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2923.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2923.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECT", "code_information": [{"code": "33720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1570.27, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1570.27, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1570.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1570.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1570.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1801.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1801.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1801.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1801.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1801.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1905.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1905.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1905.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1905.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1905.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33692", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1980.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1980.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1980.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1980.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1980.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33694", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1928.79, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1928.79, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1928.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1928.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1928.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33697", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2134.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2134.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2134.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2134.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2134.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1567.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1567.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1567.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1567.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1567.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1747.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1747.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1747.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1747.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1747.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART WOUND", "code_information": [{"code": "33300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2171.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2171.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2171.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2171.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2171.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART WOUND", "code_information": [{"code": "33305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3540.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3540.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3540.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3540.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3540.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HUMERUS", "code_information": [{"code": "24430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HYDROCELE", "code_information": [{"code": "55060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF IMPERFORATED ANUS", "code_information": [{"code": "46742", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2167.15, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2167.15, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2167.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2167.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2167.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KIDNEY WOUND", "code_information": [{"code": "50500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1173.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1173.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1173.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1173.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1173.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE CARTILAGE", "code_information": [{"code": "27403", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENT", "code_information": [{"code": "27405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENT", "code_information": [{"code": "27407", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENTS", "code_information": [{"code": "27409", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEECAP TENDON", "code_information": [{"code": "27380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG EPIPHYSES", "code_information": [{"code": "27740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG EPIPHYSES", "code_information": [{"code": "27742", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG NERVE", "code_information": [{"code": "64840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27658", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27659", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27664", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOW BACK NERVES", "code_information": [{"code": "64862", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1184.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1184.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1184.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1184.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1184.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1021.63, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1021.63, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1021.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1021.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1021.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MESENTERY", "code_information": [{"code": "44850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 683.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 683.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 683.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 683.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 683.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF METATARSALS", "code_information": [{"code": "28322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2529.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2529.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2529.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2529.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2529.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2381.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2381.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2381.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2381.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2381.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33427", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2516.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2516.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2516.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2516.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2516.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NAIL BED", "code_information": [{"code": "6900139", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR OF NAIL BED", "code_information": [{"code": "6900139", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR OF NAIL BED", "code_information": [{"code": "11760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6440.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NASAL SEPTUM", "code_information": [{"code": "30520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8931.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF PENIS", "code_information": [{"code": "54440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF PERINEUM", "code_information": [{"code": "56810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 23828.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTOCELE", "code_information": [{"code": "45560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTUM", "code_information": [{"code": "45500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTUM", "code_information": [{"code": "45505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED SPLEEN", "code_information": [{"code": "38115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1131.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1131.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1131.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1131.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1131.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED TENDON", "code_information": [{"code": "24342", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED UTERUS", "code_information": [{"code": "58520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 766.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 766.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 766.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 766.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 766.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SHOULDER", "code_information": [{"code": "23420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SKULL & BRAIN", "code_information": [{"code": "62145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPERM DUCT", "code_information": [{"code": "55400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1163.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1163.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1163.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1163.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1163.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1265.15, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1265.15, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1265.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1265.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1265.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63704", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1461.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1461.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1461.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1461.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1461.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63706", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1687.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1687.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1687.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1687.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1687.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STERNUM SEPARATION", "code_information": [{"code": "21750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 699.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 699.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 699.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 699.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 699.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STOMACH LESION", "code_information": [{"code": "43840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1180.17, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1180.17, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1180.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1180.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1180.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF THIGH", "code_information": [{"code": "27470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1168.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1168.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1168.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1168.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1168.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF THIGH MUSCLE", "code_information": [{"code": "27385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA", "code_information": [{"code": "27720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 877.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 877.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 877.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 877.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 877.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA EPIPHYSIS", "code_information": [{"code": "27730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TOE DISLOCATION", "code_information": [{"code": "28675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER", "code_information": [{"code": "50900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 867.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 867.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 867.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 867.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 867.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER LESION", "code_information": [{"code": "51535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 76178.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 817.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 817.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 817.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 817.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 817.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17320.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 19885.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRAL LESION", "code_information": [{"code": "57230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF UTERUS", "code_information": [{"code": "59350", "type": "CPT"}], "standard_charges": [{"minimum": 274.62, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 274.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 274.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 274.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 274.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 274.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF VAGINA", "code_information": [{"code": "56800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF VAGINA", "code_information": [{"code": "57200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1357.8, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1357.8, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1357.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1357.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1357.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE DEFECT", "code_information": [{"code": "31825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 713.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 713.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 713.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 713.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 713.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 819.63, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 819.63, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 819.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 819.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 819.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OVIDUCT", "code_information": [{"code": "58750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 895.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 895.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 895.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 895.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 895.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42182", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE PHARYNX/UVULA", "code_information": [{"code": "42145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 9201.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT LAP", "code_information": [{"code": "57423", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 895.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 895.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 895.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 895.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 895.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT OPEN", "code_information": [{"code": "57284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 831.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 831.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 831.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 831.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 831.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT VAG", "code_information": [{"code": "57285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 649.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 649.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 649.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 649.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 649.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS", "code_information": [{"code": "54380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS", "code_information": [{"code": "54385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS AND BLADDER", "code_information": [{"code": "54390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1205.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1205.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1205.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1205.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1205.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PROSTH VALVE CLOT", "code_information": [{"code": "33496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1687.3, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1687.3, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1687.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1687.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1687.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PUL VENOUS STENOSIS", "code_information": [{"code": "33726", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2024.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2024.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2024.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2024.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2024.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ARTERY", "code_information": [{"code": "33917", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1481.1, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1481.1, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1481.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1481.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1481.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ATRESIA", "code_information": [{"code": "33920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1779.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1779.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1779.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1779.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1779.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RADIUS & ULNA", "code_information": [{"code": "25415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RADIUS OR ULNA", "code_information": [{"code": "25400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECT/BLADDER FISTULA", "code_information": [{"code": "45800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1126.33, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1126.33, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1126.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1126.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1126.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTOURETHRAL FISTULA", "code_information": [{"code": "45820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1123.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1123.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1123.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1123.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1123.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM & VAGINA", "code_information": [{"code": "57250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 21423.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM-VAGINA FISTULA", "code_information": [{"code": "57300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM-VAGINA FISTULA", "code_information": [{"code": "57305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 858.95, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 858.95, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 858.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 858.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 858.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM/REMOVE SIGMOID", "code_information": [{"code": "45550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1339.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1339.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1339.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1339.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1339.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RETINAL DETACH CPLX", "code_information": [{"code": "67113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ROTATOR CUFF ACUTE", "code_information": [{"code": "23410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ROTATOR CUFF CHRONIC", "code_information": [{"code": "23412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RUPTD POPLITEAL ART", "code_information": [{"code": "35152", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1519.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1519.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1519.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1519.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1519.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SALIVARY DUCT", "code_information": [{"code": "42500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SALIVARY DUCT", "code_information": [{"code": "42505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SCIATIC NERVE", "code_information": [{"code": "64858", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33813", "type": "CPT"}], "standard_charges": [{"minimum": 1272.98, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1272.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1272.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1272.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1272.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1272.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33814", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1547.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1547.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1547.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1547.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1547.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1495.33, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1495.33, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1495.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1495.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1495.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33853", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1862.04, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1862.04, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1862.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1862.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1862.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23462", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23466", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33617", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2189.37, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2189.37, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2189.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2189.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2189.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33619", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2745.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2745.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2745.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2745.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2745.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SKULL CAVITY LESION", "code_information": [{"code": "62120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1747.04, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1747.04, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1747.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1747.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1747.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9949", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SPINAL FLUID LEAKAGE", "code_information": [{"code": "63707", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 860.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 860.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 860.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 860.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 860.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SPINAL FLUID LEAKAGE", "code_information": [{"code": "63709", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1045.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1045.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1045.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1045.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1045.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR STERN/NUSS W/O SCOPE", "code_information": [{"code": "21742", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR STERNUM/NUSS W/SCOPE", "code_information": [{"code": "21743", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH OPENING", "code_information": [{"code": "43870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH-BOWEL FISTULA", "code_information": [{"code": "43880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1463.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1463.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1463.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1463.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1463.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TCAT MITRAL VALVE", "code_information": [{"code": "33418", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TCAT MITRAL VALVE", "code_information": [{"code": "33419", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TEAR DUCTS", "code_information": [{"code": "68700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TESTIS INJURY", "code_information": [{"code": "54670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT ESOPHAGUS", "code_information": [{"code": "42953", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1061.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1061.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1061.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1061.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1061.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT WOUND", "code_information": [{"code": "42900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TOE DISLOCATION", "code_information": [{"code": "28645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TOOTH SOCKET", "code_information": [{"code": "41874", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 193.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 193.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 193.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 193.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 193.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TUNNELED CV CATH", "code_information": [{"code": "36575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 253.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TUNNELED CV CATH", "code_information": [{"code": "36576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4537.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4537.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4537.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4537.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4537.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1052.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1052.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1052.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1052.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1052.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 643.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 643.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 643.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 643.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 643.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 596.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 596.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 596.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 596.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 596.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UPPER JAW FISTULA", "code_information": [{"code": "30580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR URETHROVAGINAL LESION", "code_information": [{"code": "57310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 477.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 477.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 477.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 477.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 477.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR URETHROVAGINAL LESION", "code_information": [{"code": "57311", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 541.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 541.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 541.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 541.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 541.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR URO SPHINCTER", "code_information": [{"code": "53449", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VAGINA", "code_information": [{"code": "57335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1123.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1123.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1123.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1123.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1123.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VAGINA/PERINEUM", "code_information": [{"code": "57210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VALVE FEMORAL VEIN", "code_information": [{"code": "34501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 985.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 985.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 985.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 985.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 985.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VENOUS ANOMALY", "code_information": [{"code": "33724", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1538.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1538.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1538.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1538.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1538.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33803", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1156.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1156.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1156.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1156.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1156.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL GRAFT DEFECT", "code_information": [{"code": "35870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1330.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1330.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1330.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1330.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1330.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR WEBBED TOE(S)", "code_information": [{"code": "28345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR WINDPIPE OPENING", "code_information": [{"code": "31613", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR WINDPIPE OPENING", "code_information": [{"code": "31614", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR WRIST JOINTS", "code_information": [{"code": "25447", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT ACHILLES TENDON", "code_information": [{"code": "27652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT EYE LESION", "code_information": [{"code": "66225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FEMUR HEAD/NECK", "code_information": [{"code": "27170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1165.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1165.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1165.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1165.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1165.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26428", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26434", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26352", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26358", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26372", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26392", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT KNEECAP TENDON", "code_information": [{"code": "27381", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF BRONCHUS", "code_information": [{"code": "31770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1319.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1319.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1319.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1319.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1319.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF FOOT TENDON", "code_information": [{"code": "28202", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF FOOT TENDON", "code_information": [{"code": "28210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 30815.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF THIGH", "code_information": [{"code": "27472", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1263.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1263.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1263.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1263.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1263.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF THIGH MUSCLE", "code_information": [{"code": "27386", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF TIBIA", "code_information": [{"code": "27722", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 873.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 873.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 873.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 873.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 873.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF TIBIA", "code_information": [{"code": "27724", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1271.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1271.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1271.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1271.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1271.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS & ULNA", "code_information": [{"code": "25420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS & ULNA", "code_information": [{"code": "25426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS OR ULNA", "code_information": [{"code": "25405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 27893.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS OR ULNA", "code_information": [{"code": "25425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT WRIST BONE", "code_information": [{"code": "25440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/REVISE WRIST JOINT", "code_information": [{"code": "25320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/TRANSPOSE NERVE", "code_information": [{"code": "64856", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPEAT CONTROL OF NOSEBLEED", "code_information": [{"code": "30906", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 50.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPEAT THYROID SURGERY", "code_information": [{"code": "60260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1048.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1048.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1048.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1048.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1048.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPL GASTRO TUBE W/FLUOR", "code_information": [{"code": "4909450", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2680.0, "discounted_cash": 2010.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REPL GASTRO TUBE W/FLUOR", "code_information": [{"code": "4919450", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2680.0, "discounted_cash": 2010.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REPL GJ TUBE W/FLUOR", "code_information": [{"code": "4919453", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3989.0, "discounted_cash": 2991.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REPL J-TUBE W/FLUOR", "code_information": [{"code": "4919452", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2482.0, "discounted_cash": 1861.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33362", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33363", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33364", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE PERQ", "code_information": [{"code": "33361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33367", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33368", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33369", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE BRAIN CAVITY SHUNT", "code_information": [{"code": "62258", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1057.4, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1057.4, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1057.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1057.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1057.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE CVAD CATH", "code_information": [{"code": "36580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE ELBOW JOINT", "code_information": [{"code": "24363", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE EYE FLUID", "code_information": [{"code": "67025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1244.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE G-J TUBE PERC", "code_information": [{"code": "49452", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE G/C TUBE PERC", "code_information": [{"code": "49450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3192.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 144.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE MATERIAL PROSTHESIS", "code_information": [{"code": "D6197", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE PICVAD CATH", "code_information": [{"code": "36585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TRICUSPID VALVE", "code_information": [{"code": "33465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2563.58, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2563.58, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2563.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2563.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2563.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "4916581", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5607.0, "discounted_cash": 4205.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36578", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36581", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1077.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36582", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36583", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE URETER BY BOWEL", "code_information": [{"code": "50840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1270.26, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1270.26, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1270.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1270.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1270.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/BP", "code_information": [{"code": "33983", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/O BP", "code_information": [{"code": "33982", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD PUMP EXT", "code_information": [{"code": "33981", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62194", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 381.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 470.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 470.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 470.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 470.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 470.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE/REVISE BRAIN SHUNT", "code_information": [{"code": "62230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 39605.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2335.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2335.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2335.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2335.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2335.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2821.07, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2821.07, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2821.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2821.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2821.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2482.95, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2482.95, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2482.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2482.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2482.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33411", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3196.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3196.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3196.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3196.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3196.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2529.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2529.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2529.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2529.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2529.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33413", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3256.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3256.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3256.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3256.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3256.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF MITRAL VALVE", "code_information": [{"code": "33430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2710.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2710.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2710.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2710.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2710.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT PULMONARY VALVE", "code_information": [{"code": "33475", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2291.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2291.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2291.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2291.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2291.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANT FOREARM COMPLETE", "code_information": [{"code": "20805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3095.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3095.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3095.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3095.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3095.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION ARM COMPLETE", "code_information": [{"code": "20802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2345.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2345.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2345.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2345.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2345.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20816", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2466.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2466.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2466.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2466.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2466.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION FOOT COMPLETE", "code_information": [{"code": "20838", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2322.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2322.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2322.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2322.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2322.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION HAND COMPLETE", "code_information": [{"code": "20808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4019.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4019.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4019.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4019.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4019.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION OF PENIS", "code_information": [{"code": "54438", "type": "CPT"}], "standard_charges": [{"minimum": 12252.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20824", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2436.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2436.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2436.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2436.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2436.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20827", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2219.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2219.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2219.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2219.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2219.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLC COMP CVAD W SQ PRT", "code_information": [{"code": "4916585", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9849.0, "discounted_cash": 7386.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REPLCE CATH ONLY CVAD", "code_information": [{"code": "4916578", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10636.0, "discounted_cash": 7977.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REPLCE NON-TUNNL CV CATH", "code_information": [{"code": "4916580", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8241.0, "discounted_cash": 6180.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REPOS CAR MODULJ TRANVNS ELT", "code_information": [{"code": "415T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOS ENDO VENACAVA FILT", "code_information": [{"code": "4917192", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16480.0, "discounted_cash": 12360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REPOS GI TUBE THRU DUODN", "code_information": [{"code": "4913761", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"gross_charge": 8573.0, "discounted_cash": 6429.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REPOS PREV IMPLTBL SUBQ DFB", "code_information": [{"code": "33273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOS PREV SS IMPL DFB ELTRD", "code_information": [{"code": "574T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSG PERQ R/L HRT VAD", "code_information": [{"code": "33993", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSG PHRNC NRV STIM TRNSVN", "code_information": [{"code": "33281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION GASTROSTOMY TUBE", "code_information": [{"code": "43761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION INTRAOCULAR LENS", "code_information": [{"code": "66825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION L VENTRIC LEAD", "code_information": [{"code": "33226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION PACING-DEFIB LEAD", "code_information": [{"code": "33215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION VENOUS CATHETER", "code_information": [{"code": "36597", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITN CV CATH W/FLURO", "code_information": [{"code": "4914240", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4860.0, "discounted_cash": 3645.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REPOSITN CV CATH W/FLURO", "code_information": [{"code": "6296597", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5385.0, "discounted_cash": 4038.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REPR ELBOW LAT LIGMNT W/TISS", "code_information": [{"code": "24343", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR ELBW MED LIGMNT W/TISSU", "code_information": [{"code": "24345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR OF ANAL FISTULA W/GLUE", "code_information": [{"code": "46706", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1347.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH DBL PROC", "code_information": [{"code": "46712", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2018.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2018.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2018.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2018.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2018.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH SNGL PROC", "code_information": [{"code": "46710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 974.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 974.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 974.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 974.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 974.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR PUL ART UNIFOCAL W/CPB", "code_information": [{"code": "33926", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2459.91, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2459.91, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2459.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2459.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2459.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPRDTVE MED ALYS 24 CHRMSM", "code_information": [{"code": "254U", "type": "CPT"}], "standard_charges": [{"minimum": 759.05, "maximum": 759.05, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 759.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 759.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPRGRMG IO RTA ELTRD RA", "code_information": [{"code": "473T", "type": "CPT"}], "standard_charges": [{"minimum": 160.08, "maximum": 183.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 164.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 160.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPRIZA, 1CM", "code_information": [{"code": "Q4143", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT 7/>", "code_information": [{"code": "92604", "type": "CPT"}], "standard_charges": [{"minimum": 93.57, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 93.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 93.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 93.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 93.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 93.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT <7", "code_information": [{"code": "92602", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPS PREV LD VEN LTVENT", "code_information": [{"code": "4613226", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 18002.0, "discounted_cash": 13501.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REPS TRNSV LD RT ATR/VNT", "code_information": [{"code": "4613215", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6174.0, "discounted_cash": 4630.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REPTILASE TEST", "code_information": [{"code": "85635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 50.22, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REREMOVE WRIST TENDON LESION", "code_information": [{"code": "25112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREPAIR FEM HERNIA BLOCKED", "code_information": [{"code": "49557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREPAIR FEM HERNIA REDUCE", "code_information": [{"code": "49555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREPAIR ING HERNIA BLOCKED", "code_information": [{"code": "49521", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREPAIR ING HERNIA REDUCE", "code_information": [{"code": "49520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "estimated_discounted_cash": 37644.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREVISE EYE MUSCLES ADD-ON", "code_information": [{"code": "67332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUM/CHEST", "code_information": [{"code": "32504", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2089.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2089.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2089.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2089.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2089.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUMOR", "code_information": [{"code": "32503", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1835.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1835.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1835.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1835.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1835.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT BACK TUM 5 CM/>", "code_information": [{"code": "21936", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT BACK TUM < 5 CM", "code_information": [{"code": "21935", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT CLAVICLE TUMOR", "code_information": [{"code": "23200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM COMPLEX", "code_information": [{"code": "39561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1177.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1177.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1177.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1177.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1177.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM SIMPLE", "code_information": [{"code": "39560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 762.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 762.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 762.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 762.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 762.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT DISTAL FINGER TUMOR", "code_information": [{"code": "26262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT ENLARGED TOE", "code_information": [{"code": "28341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT ENLARGED TOE TISSUE", "code_information": [{"code": "28340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FACE/SCALP TUM 2 CM/>", "code_information": [{"code": "21016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FACE/SCALP TUM < 2 CM", "code_information": [{"code": "21015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FEMUR/KNEE TUMOR", "code_information": [{"code": "27365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1204.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1204.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1204.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1204.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1204.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FIBULA TUMOR", "code_information": [{"code": "27646", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 942.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 942.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 942.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 942.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 942.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR 3 CM/>", "code_information": [{"code": "28047", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR < 3 CM", "code_information": [{"code": "28046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FORARM/WRIST TUM 3CM>", "code_information": [{"code": "25078", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FOREARM/WRIST TUM<3CM", "code_information": [{"code": "25077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HEART SAC LESION", "code_information": [{"code": "33050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 990.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 990.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 990.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 990.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 990.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM INCL ACETABUL", "code_information": [{"code": "27076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1568.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1568.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1568.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1568.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1568.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM W/INNOM BONE", "code_information": [{"code": "27077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2617.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2617.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2617.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2617.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2617.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUMOR", "code_information": [{"code": "27075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2238.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2238.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2238.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2238.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2238.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM 5 CM/>", "code_information": [{"code": "27059", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM < 5 CM", "code_information": [{"code": "27049", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT INFERIOR TURBINATE", "code_information": [{"code": "30140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8849.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM 5 CM/>", "code_information": [{"code": "27616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM < 5 CM", "code_information": [{"code": "27615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL CYST", "code_information": [{"code": "39200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 890.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 890.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 890.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 890.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 890.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL TUMOR", "code_information": [{"code": "39220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1138.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1138.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1138.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1138.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1138.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT METATARSAL TUMOR", "code_information": [{"code": "28173", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 21860.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT NASOPHARYNX SKULL", "code_information": [{"code": "61586", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2103.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2103.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2103.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2103.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2103.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT NECK THORAX TUMOR<5CM", "code_information": [{"code": "21557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT NECK TUMOR 5 CM/>", "code_information": [{"code": "21558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1044.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1044.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1044.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1044.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1044.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1341.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1341.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1341.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1341.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1341.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58952", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1514.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1514.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1514.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1514.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1514.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT PHALANX OF TOE TUMOR", "code_information": [{"code": "28175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6452.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT PROX FINGER TUMOR", "code_information": [{"code": "26260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT PROX HUMERUS TUMOR", "code_information": [{"code": "23220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1058.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1058.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1058.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1058.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1058.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT RADIUS/ULNAR TUMOR", "code_information": [{"code": "25170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 958.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 958.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 958.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 958.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 958.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT RECUR GYN MAL W/LYM", "code_information": [{"code": "58958", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1567.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1567.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1567.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1567.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1567.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT RECURRENT GYN MAL", "code_information": [{"code": "58957", "type": "CPT"}], "standard_charges": [{"minimum": 1418.68, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1418.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1418.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1418.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1418.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1418.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT SCAPULA TUMOR", "code_information": [{"code": "23210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 897.27, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 897.27, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 897.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 897.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 897.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT SHOULDER TUMOR 5 CM/>", "code_information": [{"code": "23078", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT SHOULDER TUMOR < 5 CM", "code_information": [{"code": "23077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT TALUS/CALCANEUS TUM", "code_information": [{"code": "27647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT TARSAL TUMOR", "code_information": [{"code": "28171", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT THIGH/KNEE TUM 5 CM/>", "code_information": [{"code": "27364", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT THIGH/KNEE TUM < 5 CM", "code_information": [{"code": "27329", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT TIBIA TUMOR", "code_information": [{"code": "27645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1055.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1055.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1055.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1055.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1055.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/DEBRIDE PANCREAS", "code_information": [{"code": "48105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2585.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2585.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2585.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2585.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2585.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2245.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2245.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2245.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2245.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2245.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2145.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2145.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2145.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2145.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2145.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2827.14, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2827.14, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2827.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2827.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2827.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2631.58, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2631.58, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2631.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2631.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2631.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3091.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3091.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3091.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3091.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3091.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE LESION SKULL", "code_information": [{"code": "61615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2371.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2371.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2371.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2371.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2371.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE LESION SKULL", "code_information": [{"code": "61616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3125.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3125.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3125.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3125.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3125.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECTION OF ELBOW JOINT", "code_information": [{"code": "24155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESERV CLOVERLEAF TITAN", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "8155033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3227.91, "maximum": 3227.91, "gross_charge": 15371.0, "discounted_cash": 11528.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3227.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESERV PENL PROSTH FLAT", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "8155034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2582.37, "maximum": 2582.37, "gross_charge": 12297.0, "discounted_cash": 9222.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2582.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESET DISLOCATED JAW", "code_information": [{"code": "21480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESET DISLOCATED JAW", "code_information": [{"code": "21485", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESHAPING BONE ORTHOGNATHIC", "code_information": [{"code": "D7940", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 12-25 AMP PROBE", "code_information": [{"code": "87633", "type": "CPT"}, {"code": "7000168", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2128.5, "gross_charge": 5669.0, "discounted_cash": 4251.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2128.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 3-5 AMP PROBE", "code_information": [{"code": "87631", "type": "CPT"}, {"code": "4107631", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 586.52, "gross_charge": 752.0, "discounted_cash": 564.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 586.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 6-11 TARGETS", "code_information": [{"code": "87632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1039.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1039.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 218.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 218.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPI SYNC VIRUS DIR OPT", "code_information": [{"code": "87807", "type": "CPT"}, {"code": "4100025", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPI SYNC VIRUS DIR OPT", "code_information": [{"code": "87807", "type": "CPT"}, {"code": "7250025", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 75.0, "discounted_cash": 56.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPI SYNCTIAL VIRUS AB", "code_information": [{"code": "86756", "type": "CPT"}, {"code": "7256756", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.74, "gross_charge": 281.0, "discounted_cash": 210.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.74, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIR IADNA 18 VIRAL&2 BACT", "code_information": [{"code": "115U", "type": "CPT"}], "standard_charges": [{"minimum": 275.35, "maximum": 275.35, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 275.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 275.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 42164.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 38828.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51028.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 91401.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 42164.96, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 22519.63, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 20337.07, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 57063.55, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 28869.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25027.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31538.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [{"code": "204", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4380.77, "maximum": 33780.81, "estimated_discounted_cash": 35415.62, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", 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CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11484.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27254.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13500.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17393.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27254.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11484.2, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5744.06, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 15737.12, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4380.77, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8204.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26807.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33780.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYNCYTIAL AG IF", "code_information": [{"code": "87280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 13.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS", "code_information": [{"code": "208", "type": "MS-DRG"}], "standard_charges": [{"minimum": 91262.34, "maximum": 115002.86, "estimated_discounted_cash": 115053.36, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 91262.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 115002.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [{"code": "207", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5260.06, "maximum": 269221.41, "estimated_discounted_cash": 182795.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9918.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29288.56, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17284.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12427.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30818.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18187.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13076.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10436.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32543.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19205.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13807.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11020.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF 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rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13807.95, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5260.06, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7623.95, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 20051.36, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10878.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 213644.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 269221.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPITE CARE, IN THE HOME, P", "code_information": [{"code": "S9125", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESTORE/REMODEL VENTRICLE", "code_information": [{"code": "33548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2897.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2897.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2897.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2897.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2897.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESUSCITATION BAG", "code_information": [{"code": "S8999", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETEPLASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2993", "type": "HCPCS"}], "standard_charges": [{"minimum": 3099.58, "maximum": 3443.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3099.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3443.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3443.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3443.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3443.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETIC AUTO CELLPARAMETRS", "code_information": [{"code": "85046", "type": "CPT"}, {"code": "7255046", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.47, "gross_charge": 142.0, "discounted_cash": 106.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 28.47, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.8, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULATED PLATELET ASSAY", "code_information": [{"code": "85055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 136.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 136.55, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.37, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULOCYTE COUNT AUTO", "code_information": [{"code": "85045", "type": "CPT"}, {"code": "4105045", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.4, "gross_charge": 132.0, "discounted_cash": 99.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 20.4, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC", "code_information": [{"code": "815", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4778.67, "maximum": 42424.75, "estimated_discounted_cash": 49517.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16825.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10268.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7212.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 35333.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17703.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10804.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7588.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 37179.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11409.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8013.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39260.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18694.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39260.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18694.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11409.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8013.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18694.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8013.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11409.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39260.28, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7329.12, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 22890.13, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 12561.78, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4778.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33666.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42424.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC", "code_information": [{"code": "814", "type": "MS-DRG"}], "standard_charges": [{"minimum": 70610.69, "maximum": 88979.0, "estimated_discounted_cash": 84030.6, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 70610.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 88979.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "816", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4310.33, "maximum": 27372.41, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10327.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24634.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13649.54, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9755.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14362.48, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25921.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10867.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10264.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15166.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27372.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11475.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10839.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15166.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27372.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11475.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10839.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15166.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27372.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11475.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10839.18, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6158.91, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4310.33, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16714.25, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7407.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20983.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26442.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETINAL TAMP, SILICONE OIL", "code_information": [{"code": "C1814", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETR BONE FLAP TO FIX SKULL", "code_information": [{"code": "62148", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 119.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 119.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 119.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 119.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 119.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETRIEVAL OF OOCYTE", "code_information": [{"code": "58970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETRIEVER VASCULR 4-LOOP", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "8184821", "type": "CDM"}], "standard_charges": [{"minimum": 694.26, "maximum": 694.26, "gross_charge": 3306.0, "discounted_cash": 2479.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 694.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETROGRADE EJACULATION ANAL", "code_information": [{"code": "89331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 100.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 100.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REUSABLE ENEMA BAG", "code_information": [{"code": "A4458", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE ORAL THERMOMETER", "code_information": [{"code": "A4931", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE PULL-ON ANY SIZE", "code_information": [{"code": "T4536", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE RECTAL THERMOMETER", "code_information": [{"code": "A4932", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE UNDERPAD BED SIZE", "code_information": [{"code": "T4537", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE UNDERPAD CHAIR SIZE", "code_information": [{"code": "T4540", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSE DIAPER/BRIEF ANY SIZE", "code_information": [{"code": "T4539", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV ARTIFIC DISC ADDL", "code_information": [{"code": "98T", "type": "CPT"}], "standard_charges": [{"minimum": 4200.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV RPLC/RMV THRC VRT TETHRG", "code_information": [{"code": "22838", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV RPLCM ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV RPLCM RTHRP 1NTRSPC LMBR", "code_information": [{"code": "22862", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2008.52, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2008.52, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2008.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2008.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2008.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV GEN", "code_information": [{"code": "271T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV LEAD", "code_information": [{"code": "270T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV TOTAL", "code_information": [{"code": "269T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/RMV IMP SP NPG/R DTCH CN", "code_information": [{"code": "63688", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1538.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1538.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1538.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1538.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1538.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/RMV PERPH NSTIM ELTRD RA", "code_information": [{"code": "64585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 13108.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/RMV PRPH SAC/GSTR NPG/R", "code_information": [{"code": "64595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14571.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1538.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1538.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1538.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1538.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1538.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/RPLCMT SK-MNT CRNL NSTM", "code_information": [{"code": "61891", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/RPLCT HPGLSL NSTM ARY PG", "code_information": [{"code": "64583", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVAS PERC TRANS OCC ADD", "code_information": [{"code": "92944", "type": "CPT"}, {"code": "4612944", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48755.9, "gross_charge": 51322.0, "discounted_cash": 38491.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 10777.62, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 48755.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 48755.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18937.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 38491.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 38491.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVAS PERC TRANS OCCL MI", "code_information": [{"code": "92941", "type": "CPT"}, {"code": "4612941", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51119.5, "gross_charge": 53810.0, "discounted_cash": 40357.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 11300.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 51119.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "standard_charge_dollar": 13452.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "standard_charge_dollar": 18833.5, "methodology": "fee schedule"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "standard_charge_dollar": 16143.0, "methodology": "fee schedule"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "standard_charge_dollar": 26905.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "standard_charge_dollar": 13452.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 51119.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19855.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 40357.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 40357.5, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 34976.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVAS PERC TRANS SGL VES", "code_information": [{"code": "92937", "type": "CPT"}, {"code": "4612937", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45144.0, "gross_charge": 47520.0, "discounted_cash": 35640.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 9979.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 45144.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 45144.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17534.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 35640.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 35640.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVAS PERC TRANS TOT OCC", "code_information": [{"code": "92943", "type": "CPT"}, {"code": "4612943", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54832.1, "gross_charge": 57718.0, "discounted_cash": 43288.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 12120.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25570.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 54832.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 54832.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21297.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 43288.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 43288.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC FEMPOP STNT ATHER", "code_information": [{"code": "4610235", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 95011.0, "discounted_cash": 71258.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC FEMPOP STNT ATHER", "code_information": [{"code": "4918182", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 66051.0, "discounted_cash": 49538.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC FEMPOP W/ATHER", "code_information": [{"code": "4610233", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 62954.0, "discounted_cash": 47215.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC FEMPOP W/ATHER", "code_information": [{"code": "4918180", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 58835.0, "discounted_cash": 44126.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC FEMPOP W/STENT", "code_information": [{"code": "4610231", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 24100.0, "discounted_cash": 18075.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC FEMPOP W/STENT", "code_information": [{"code": "4918178", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 45749.0, "discounted_cash": 34311.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC FEMPOP W/TLA", "code_information": [{"code": "4610229", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 22703.0, "discounted_cash": 17027.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC FEMPOP W/TLA", "code_information": [{"code": "4918176", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 22703.0, "discounted_cash": 17027.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILI W/STENT ADD/O", "code_information": [{"code": "4610227", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21911.0, "discounted_cash": 16433.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILI W/STENT ADD/O", "code_information": [{"code": "4918174", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20349.0, "discounted_cash": 15261.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILIAC ADD ON", "code_information": [{"code": "4610223", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 32183.0, "discounted_cash": 24137.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILIAC ADD ON", "code_information": [{"code": "4918170", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 22512.0, "discounted_cash": 16884.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILIAC INITIAL", "code_information": [{"code": "4610221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 33006.0, "discounted_cash": 24754.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILIAC INITIAL", "code_information": [{"code": "4918168", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 22703.0, "discounted_cash": 17027.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILIAC W/STENT", "code_information": [{"code": "4610225", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 25647.0, "discounted_cash": 19235.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILIAC W/STENT", "code_information": [{"code": "4918172", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 48016.0, "discounted_cash": 36012.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-ATHER", "code_information": [{"code": "C9766", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-STENT", "code_information": [{"code": "C9765", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC INTRAVASC LITHOTRIPSY", "code_information": [{"code": "C9764", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITH-STEN-ATH TIB/PER", "code_information": [{"code": "C9775", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-ATHER TIB/PER", "code_information": [{"code": "C9774", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-STENT TIB/PER", "code_information": [{"code": "C9773", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP TIBI/PERONE", "code_information": [{"code": "C9772", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP-STENT-ATHER", "code_information": [{"code": "C9767", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC TIB PER ADD ON", "code_information": [{"code": "4610239", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 25857.0, "discounted_cash": 19392.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIB PER ADD ON", "code_information": [{"code": "4918186", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17625.0, "discounted_cash": 13218.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIB PER ATH ADD/O", "code_information": [{"code": "4610243", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 39472.0, "discounted_cash": 29604.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIB PER ATH ADD/O", "code_information": [{"code": "4918190", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 58835.0, "discounted_cash": 44126.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER ST ATH ADD", "code_information": [{"code": "4610251", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 57765.0, "discounted_cash": 43323.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER ST ATH ADD", "code_information": [{"code": "4918198", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 55157.0, "discounted_cash": 41367.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER STNT ATHER", "code_information": [{"code": "4610249", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 100804.0, "discounted_cash": 75603.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER STNT ATHER", "code_information": [{"code": "4918196", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 101898.0, "discounted_cash": 76423.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER W/ATHER", "code_information": [{"code": "4610241", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 47250.0, "discounted_cash": 35437.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER W/ATHER", "code_information": [{"code": "4918188", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 57035.0, "discounted_cash": 42776.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER W/STENT", "code_information": [{"code": "4610245", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 50140.0, "discounted_cash": 37605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER W/STENT", "code_information": [{"code": "4918192", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 49859.0, "discounted_cash": 37394.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER W/TLA", "code_information": [{"code": "4610237", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 34408.0, "discounted_cash": 25806.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER W/TLA", "code_information": [{"code": "4918184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 14937.0, "discounted_cash": 11202.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER WSTENTADD", "code_information": [{"code": "4610247", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 43227.0, "discounted_cash": 32420.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER WSTENTADD", "code_information": [{"code": "4918194", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 27713.0, "discounted_cash": 20784.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASCULARIZATION PENIS", "code_information": [{"code": "37788", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1346.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1346.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1346.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1346.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1346.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVEFENACIN INH NON-COM 1MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7677", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.17, "maximum": 0.19, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVERSE OSMOSIS H2O PURI SYS", "code_information": [{"code": "E1610", "type": "HCPCS"}], "standard_charges": [{"minimum": 897.03, "maximum": 1025.82, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 923.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 897.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1025.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1025.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1025.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVERSE T3", "code_information": [{"code": "84482", "type": "CPT"}, {"code": "7254905", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 80.37, "gross_charge": 459.0, "discounted_cash": 344.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 80.37, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.27, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVIEW PATIENT SPIROMETRY", "code_information": [{"code": "94016", "type": "CPT"}], "standard_charges": [{"minimum": 25.26, "maximum": 57.15, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 51.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 49.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.15, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVIS RECONST SHOULDER JOINT", "code_information": [{"code": "23473", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVIS RECONST SHOULDER JOINT", "code_information": [{"code": "23474", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1338.73, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1338.73, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1338.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1338.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1338.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32906", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1647.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1647.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1647.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1647.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1647.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ABDOMEN-VENOUS SHUNT", "code_information": [{"code": "49426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1148.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ADDITIONAL LEG TENDON", "code_information": [{"code": "27692", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE AQUEOUS SHUNT EYE", "code_information": [{"code": "66185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1774.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ARM/LEG NERVE", "code_information": [{"code": "64708", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE BLADDER & URETER(S)", "code_information": [{"code": "51565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1336.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1336.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1336.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1336.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1336.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2427.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2427.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2427.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2427.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2427.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61708", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2032.26, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2032.26, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2032.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2032.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2032.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1831.91, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1831.91, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1831.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1831.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1831.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE CORNEA WITH IMPLANT", "code_information": [{"code": "65770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3789.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3789.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3789.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3789.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3789.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ESOPHAGUS & STOMACH", "code_information": [{"code": "43325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1240.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1240.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1240.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1240.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1240.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EXTERNAL EAR", "code_information": [{"code": "69300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE", "code_information": [{"code": "65091", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE", "code_information": [{"code": "67311", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE", "code_information": [{"code": "67314", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE ADD-ON", "code_information": [{"code": "67340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE W/SUTURE", "code_information": [{"code": "67334", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S)", "code_information": [{"code": "67318", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S) ADD-ON", "code_information": [{"code": "67320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKET IMPLANT", "code_information": [{"code": "67560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2153.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2153.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2153.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2153.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2153.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1890.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1890.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1890.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1890.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1890.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1791.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1791.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1791.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1791.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1791.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE WITH IMPLANT", "code_information": [{"code": "65093", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1685.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 325.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 325.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 325.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 325.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 325.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID DEFECT", "code_information": [{"code": "67909", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID DEFECT", "code_information": [{"code": "67911", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68362", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1035.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT", "code_information": [{"code": "26535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT EACH", "code_information": [{"code": "26135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT EACH", "code_information": [{"code": "26140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER/TOE NERVE", "code_information": [{"code": "64702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE GASTRIC PORT OPEN", "code_information": [{"code": "43886", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 26018.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35879", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 972.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 972.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 972.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 972.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 972.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35881", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1081.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1081.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1081.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1081.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1081.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HAND/FINGER TENDON", "code_information": [{"code": "26390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HAND/FOOT NERVE", "code_information": [{"code": "64704", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HEAD/NECK OF FEMUR", "code_information": [{"code": "27179", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 967.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 967.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 967.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 967.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 967.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HERNIA & SPERM VEINS", "code_information": [{"code": "55540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 36844.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JOINT REPLACEMENT", "code_information": [{"code": "27134", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1925.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1925.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1925.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1925.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1925.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JOINT REPLACEMENT", "code_information": [{"code": "27137", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1471.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1471.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1471.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1471.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1471.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JOINT REPLACEMENT", "code_information": [{"code": "27138", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1529.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1529.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1529.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1529.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1529.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE KNEECAP", "code_information": [{"code": "27437", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE KNEECAP WITH IMPLANT", "code_information": [{"code": "27438", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE KNUCKLE JOINT", "code_information": [{"code": "26530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE KNUCKLE WITH IMPLANT", "code_information": [{"code": "26531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LEG VEIN", "code_information": [{"code": "37700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LOW BACK NERVE(S)", "code_information": [{"code": "64714", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDON", "code_information": [{"code": "27690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDON", "code_information": [{"code": "27691", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDONS", "code_information": [{"code": "27686", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LUMB ARTIF DISC ADDL", "code_information": [{"code": "165T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 990.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 990.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 990.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 990.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 990.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1025.18, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1025.18, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1025.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1025.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1025.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33824", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1197.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1197.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1197.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1197.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1197.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69642", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69643", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69644", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69646", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE OVARIAN TUBE(S)", "code_information": [{"code": "58752", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 883.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 883.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 883.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 883.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 883.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1068.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1068.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1068.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1068.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1068.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54336", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1203.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1203.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1203.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1203.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1203.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PROSTH VAG GRAFT LAP", "code_information": [{"code": "57426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS & ULNA", "code_information": [{"code": "25365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS & ULNA", "code_information": [{"code": "25375", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS OR ULNA", "code_information": [{"code": "25370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPERMATIC CORD VEINS", "code_information": [{"code": "55530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 23497.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPERMATIC CORD VEINS", "code_information": [{"code": "55535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS CRVL", "code_information": [{"code": "63250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2703.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2703.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2703.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2703.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2703.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS THRC", "code_information": [{"code": "63251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2847.8, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2847.8, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2847.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2847.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2847.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE CORD VSL THRLMB", "code_information": [{"code": "63252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2830.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2830.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2830.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2830.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2830.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE ELTRD PERQ ARAY", "code_information": [{"code": "63663", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE ELTRD PLATE", "code_information": [{"code": "63664", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1494.88, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1494.88, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1494.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1494.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1494.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1558.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1558.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1558.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1558.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1558.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE TEAR DUCT OPENING", "code_information": [{"code": "68705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 129.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE THIGH MUSCLES/TENDONS", "code_information": [{"code": "27400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE TWO EYE MUSCLES", "code_information": [{"code": "67312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE TWO EYE MUSCLES", "code_information": [{"code": "67316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1078.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ULNAR NERVE AT ELBOW", "code_information": [{"code": "64718", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 42755.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ULNAR NERVE AT WRIST", "code_information": [{"code": "64719", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 527.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 527.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 527.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 527.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 527.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50728", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URETHRA STAGE 1", "code_information": [{"code": "53400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URETHRA STAGE 2", "code_information": [{"code": "53405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URINE FLOW", "code_information": [{"code": "50830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1857.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1857.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1857.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1857.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1857.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE VAG GRAFT OPEN ABD", "code_information": [{"code": "57296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 919.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 919.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 919.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 919.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 919.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE VAG GRAFT VIA VAGINA", "code_information": [{"code": "57295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 487.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 487.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 487.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 487.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 487.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE VENTRICLE MUSCLE", "code_information": [{"code": "33416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1996.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1996.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1996.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1996.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1996.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE WINDPIPE SCAR", "code_information": [{"code": "31830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE WRIST JOINT", "code_information": [{"code": "25332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE WRIST/FOREARM TENDON", "code_information": [{"code": "25280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1086.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/IMPLANT FINGER JOINT", "code_information": [{"code": "26536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2274.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE ELECTRD ANTRUM", "code_information": [{"code": "43882", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEUROELECTRODE", "code_information": [{"code": "61880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEURORECEIVER", "code_information": [{"code": "61888", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1004.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE SLING REPAIR", "code_information": [{"code": "57287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1448.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REPL VAGUS N ELTRD", "code_information": [{"code": "64569", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REPLACE KNEE JOINT", "code_information": [{"code": "27486", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 19069.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1393.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1393.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1393.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1393.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1393.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REPLACE KNEE JOINT", "code_information": [{"code": "27487", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1753.53, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1753.53, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1753.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1753.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1753.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION GASTROPLASTY", "code_information": [{"code": "43848", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1760.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1760.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1760.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1760.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1760.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF AMPUTATION", "code_information": [{"code": "24935", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1046.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1046.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1046.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1046.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1046.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ANKLE JOINT", "code_information": [{"code": "27700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF AQUEOUS SHUNT", "code_information": [{"code": "66184", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ARM NERVE(S)", "code_information": [{"code": "64713", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF BIG TOE", "code_information": [{"code": "28310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER & BOWEL", "code_information": [{"code": "51960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER NECK", "code_information": [{"code": "52500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12583.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER/URETHRA", "code_information": [{"code": "51800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1077.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1077.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1077.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1077.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1077.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CALF TENDON", "code_information": [{"code": "27687", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "57700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "57720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "59320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "59325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 241.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 241.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 241.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 241.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 241.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1365.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1365.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1365.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1365.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1365.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1480.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1480.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1480.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1480.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1480.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1270.1, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1270.1, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1270.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1270.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1270.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1443.19, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1443.19, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1443.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1443.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1443.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLLAR BONE", "code_information": [{"code": "23480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLLAR BONE", "code_information": [{"code": "23485", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 959.13, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 959.13, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 959.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 959.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 959.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 173.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 173.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 173.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 173.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 173.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65765", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CRANIAL NERVE", "code_information": [{"code": "64716", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF DIAPHRAGM", "code_information": [{"code": "39545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 886.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 886.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 886.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 886.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 886.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ELBOW JOINT", "code_information": [{"code": "24470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "21280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "21282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 722.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67882", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67961", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17320.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67966", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FEMUR EPIPHYSIS", "code_information": [{"code": "27185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 727.98, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 727.98, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 727.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 727.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 727.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FINGER", "code_information": [{"code": "26499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT", "code_information": [{"code": "28116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT AND ANKLE", "code_information": [{"code": "28262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT BONES", "code_information": [{"code": "28737", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT FASCIA", "code_information": [{"code": "28250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT TENDON", "code_information": [{"code": "28238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1978.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT TENDON", "code_information": [{"code": "28261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33476", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1488.39, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1488.39, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1488.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1488.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1488.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33478", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1605.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1605.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1605.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1605.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1605.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33735", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1270.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1270.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1270.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1270.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1270.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33736", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1468.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1468.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1468.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1468.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1468.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33737", "type": "CPT"}], "standard_charges": [{"minimum": 1321.84, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1321.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1321.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1321.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1321.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1321.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART VEINS", "code_information": [{"code": "33645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1585.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1585.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1585.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1585.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1585.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONE", "code_information": [{"code": "27147", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1435.81, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1435.81, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1435.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1435.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1435.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONES", "code_information": [{"code": "27156", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1701.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1701.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1701.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1701.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1701.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [{"code": "467", "type": "MS-DRG"}], "standard_charges": [{"minimum": 117090.17, "maximum": 147549.42, "estimated_discounted_cash": 167610.75, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 117090.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 147549.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITH MCC", "code_information": [{"code": "466", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5181.78, "maximum": 217788.73, "estimated_discounted_cash": 184813.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11417.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16225.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7971.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27168.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17072.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12014.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 28587.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8387.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12686.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18028.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8857.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30187.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12686.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30187.4, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18028.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8857.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12686.65, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8857.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18028.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30187.4, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6233.27, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5181.78, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9938.28, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16915.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 172829.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 217788.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC", "code_information": [{"code": "468", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5352.68, "maximum": 114973.57, "estimated_discounted_cash": 186494.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29613.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16894.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8603.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11833.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9053.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17776.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12451.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31160.18, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18771.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9559.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13147.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32904.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9559.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18771.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13147.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32904.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32904.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13147.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18771.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9559.84, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 30302.74, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5352.68, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6714.66, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11908.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 91239.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 114973.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP TENDON", "code_information": [{"code": "27097", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HORSESHOE KIDNEY", "code_information": [{"code": "50540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1191.95, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1191.95, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1191.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1191.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1191.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ILEOSTOMY", "code_information": [{"code": "44312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ILEOSTOMY", "code_information": [{"code": "44314", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 926.58, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 926.58, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 926.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 926.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 926.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF INFUSION PUMP", "code_information": [{"code": "36261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF IRIS", "code_information": [{"code": "66761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 194.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 194.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 194.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 194.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 194.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF IRIS", "code_information": [{"code": "66762", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 197.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 197.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 197.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 197.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 197.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1195.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1195.59, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1195.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1195.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1195.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1435.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1435.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1435.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1435.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1435.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27443", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1604.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1249.21, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1249.21, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1249.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1249.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1249.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10234.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12274.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12274.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12274.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12274.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12274.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_percentage": 36.9, "possible_amount": 13472.96, "count": "1 through 10", "median_amount": 13472.96, "methodology": "percent of total billed charges", "10th_percentile": 13472.96, "90th_percentile": 13472.96}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LARYNX", "code_information": [{"code": "31400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LEG VEIN", "code_information": [{"code": "37780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER EYELID", "code_information": [{"code": "15820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER EYELID", "code_information": [{"code": "15821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER LEG", "code_information": [{"code": "27715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1055.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1055.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1055.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1055.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1055.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER LEG TENDON", "code_information": [{"code": "27685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LUNG", "code_information": [{"code": "32940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1224.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1224.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1224.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1224.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1224.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1216.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1216.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1216.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1216.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1216.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1369.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1369.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1369.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1369.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1369.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1704.89, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1704.89, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1704.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1704.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1704.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "92987", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1497.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13169.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15059.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15059.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15059.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1497.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1497.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1497.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1497.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE/RIB", "code_information": [{"code": "21705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 607.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 607.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 607.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 607.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 607.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30462", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PELVIS", "code_information": [{"code": "27158", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1326.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1326.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1326.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1326.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1326.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PHARYNGEAL WALLS", "code_information": [{"code": "42892", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 994.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PHARYNGEAL WALLS", "code_information": [{"code": "42894", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2252.58, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2252.58, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2252.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2252.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2252.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY ARTERY", "code_information": [{"code": "33788", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "33474", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1985.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1985.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1985.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1985.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1985.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "92990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1141.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13169.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15059.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15059.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15059.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1141.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1141.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1141.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1141.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF RADIUS", "code_information": [{"code": "25350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF RADIUS", "code_information": [{"code": "25355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCIATIC NERVE", "code_information": [{"code": "64712", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCROTUM", "code_information": [{"code": "55175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCROTUM", "code_information": [{"code": "55180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF SPINAL SHUNT", "code_information": [{"code": "63744", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1621.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TESTIS", "code_information": [{"code": "54660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF THIGH MUSCLES", "code_information": [{"code": "27430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TOE", "code_information": [{"code": "28312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2225.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2225.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2225.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2225.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2225.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33468", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1907.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1907.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1907.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1907.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1907.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ULNA", "code_information": [{"code": "25360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UNSTABLE KNEECAP", "code_information": [{"code": "27420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UNSTABLE KNEECAP", "code_information": [{"code": "27422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER ARM", "code_information": [{"code": "24940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER EYELID", "code_information": [{"code": "15822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER EYELID", "code_information": [{"code": "15823", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETER", "code_information": [{"code": "50700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 968.26, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 968.26, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 968.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 968.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 968.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "53450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "53460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 21860.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "57220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 13541.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1908.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URINARY TRACT", "code_information": [{"code": "51820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1130.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1130.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1130.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1130.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1130.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UTERUS", "code_information": [{"code": "58540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 888.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 888.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 888.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 888.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 888.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF WRIST JOINT", "code_information": [{"code": "25450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF WRIST JOINT", "code_information": [{"code": "25455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION ORBITOFACIAL BONES", "code_information": [{"code": "21275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION SUBVALVULAR TISSUE", "code_information": [{"code": "33415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1973.37, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1973.37, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1973.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1973.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1973.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION TIPS", "code_information": [{"code": "37183", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 427.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 427.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 427.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 427.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 427.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION/REMOVAL ISDNS PTN", "code_information": [{"code": "588T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION/REMOVAL OF KNEECAP", "code_information": [{"code": "27424", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST AUTOG VN GRF", "code_information": [{"code": "35884", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1352.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1352.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1352.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1352.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1352.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST NONAUTOG GRF", "code_information": [{"code": "35883", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1274.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1274.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1274.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1274.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1274.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ PERI-IMPLT CAPSULE BRST", "code_information": [{"code": "19370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 21377.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ PRIOR HYPSPAD REPAIR", "code_information": [{"code": "54352", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ RECONSTRUCTED BREAST", "code_information": [{"code": "19380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1779.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ RPLCMT/RMVL VRT TETHRG", "code_information": [{"code": "790T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBF", "code_information": [{"code": "819T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBQ", "code_information": [{"code": "818T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA PN W/INT NSTIM", "code_information": [{"code": "64598", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SAC W/NSTIM", "code_information": [{"code": "787T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SPI W/NSTIM", "code_information": [{"code": "785T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVSC OPN/PRQ TIB/PERO STENT", "code_information": [{"code": "37234", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVSN INTRHEP PORTO SHNT", "code_information": [{"code": "4917183", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 65484.0, "discounted_cash": 49113.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVSN PERITONL VEN SHUNT", "code_information": [{"code": "4919428", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10517.0, "discounted_cash": 7887.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVSN/RELOC PM SKN POCKT", "code_information": [{"code": "4613222", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6405.0, "discounted_cash": 4803.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RF ABLATION ADRENAL TUMOR", "code_information": [{"code": "5050697", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21674.0, "discounted_cash": 16255.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RF ABLTJ NRV NRVTG SI JT", "code_information": [{"code": "64625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RF SPECTRSC NTRAOP MRGN ASMT", "code_information": [{"code": "546T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RFC1 REPEAT XPNSJ VRNT ALYS", "code_information": [{"code": "378U", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee 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"billing_class": "facility"}]}, {"description": "RH IG IV", "code_information": [{"code": "90386", "type": "CPT"}], "standard_charges": [{"minimum": 10.58, "maximum": 11.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHD&RHCE GNTYP NEXT GNRJ SEQ", "code_information": [{"code": "222U", "type": "CPT"}], "standard_charges": [{"minimum": 282.88, "maximum": 282.88, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHD&RHCE GNTYP RHD1-10&RHCE5", "code_information": [{"code": "198U", "type": "CPT"}], "standard_charges": [{"minimum": 282.88, "maximum": 282.88, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHEUMATOID FACTOR QUAL", "code_information": [{"code": "86430", "type": "CPT"}, {"code": "4106431", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.94, "gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHEUMATOID FACTOR QUANT", "code_information": [{"code": "86431", "type": "CPT"}, {"code": "4106432", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.94, "gross_charge": 113.0, "discounted_cash": 84.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHO(D) IMMUNE GLOBULIN H, SD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2792", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.91, "maximum": 25.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 25.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 25.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG REPORT", "code_information": [{"code": "93042", "type": "CPT"}], "standard_charges": [{"minimum": 8.06, "maximum": 15.77, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15.77, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG TRACING", "code_information": [{"code": "93041", "type": "CPT"}], "standard_charges": [{"minimum": 7.2, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG WITH REPORT", "code_information": [{"code": "93040", "type": "CPT"}], "standard_charges": [{"minimum": 15.27, "maximum": 29.68, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIA NONANTIBODY/3", "code_information": [{"code": "83519", "type": "CPT"}, {"code": "7253518", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.91, "gross_charge": 589.0, "discounted_cash": 441.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 68.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIB CARTILAGE GRAFT", "code_information": [{"code": "21230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RIBOFLAVIN(VITAMIN B2)", "code_information": [{"code": "84252", "type": "CPT"}, {"code": "7254252", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 103.22, "gross_charge": 374.0, "discounted_cash": 280.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 103.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS 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"plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIBS BI 4V MIN W/PA CXR", "code_information": [{"code": "71111", "type": "CPT"}, {"code": "5011111", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 380.1, "gross_charge": 1810.0, "discounted_cash": 1357.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 380.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 120.42, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee 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"CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 273.84, "gross_charge": 1304.0, "discounted_cash": 978.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 273.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 100.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIBS UNI 3V MIN W/PA CXR", "code_information": [{"code": "71101", "type": "CPT"}, {"code": "4901101", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 497.07, "gross_charge": 2367.0, "discounted_cash": 1775.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 497.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 87.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RISPERIDONE PER.5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2794", "type": "HCPCS"}, {"code": "5324017", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.88, "maximum": 10.98, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RITONAVIR 100 MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310670", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RITONAVIR 100 MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310670", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RITONAVIR 100 MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310639", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RITONAVIR 100 MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310639", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RITUXIMAB-ABBS PER 10MG IJ", "code_information": [{"code": "Q5115", "type": "HCPCS"}, {"code": "5324002", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 26.44, "maximum": 29.38, "gross_charge": 436.0, "discounted_cash": 327.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RITUXIMAB-ABBS PER 10MG IJ", "code_information": [{"code": "Q5115", "type": "HCPCS"}, {"code": "5324002", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 26.44, "maximum": 29.38, "gross_charge": 436.0, "discounted_cash": 327.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RITUXIMAB-PVVR PER 10MG IJ", "code_information": [{"code": "Q5119", "type": "HCPCS"}, {"code": "5324006", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 25.07, "maximum": 27.85, "gross_charge": 218.0, "discounted_cash": 163.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RITUXIMAB-PVVR PER 10MG IJ", "code_information": [{"code": "Q5119", "type": "HCPCS"}, {"code": "5324006", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 25.07, "maximum": 27.85, "gross_charge": 218.0, "discounted_cash": 163.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIV3 VACCINE NO PRESERV IM", "code_information": [{"code": "90673", "type": "CPT"}], "standard_charges": [{"minimum": 88.34, "maximum": 98.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 88.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 98.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIV4 VACC RECOMBINANT DNA IM", "code_information": [{"code": "90682", "type": "CPT"}], "standard_charges": [{"minimum": 69.53, "maximum": 77.26, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 69.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 77.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 77.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 77.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 77.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVAROXABAN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310640", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RIVAROXABAN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310640", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RIVAROXABAN 15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310632", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RIVAROXABAN 15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310632", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RIVAROXABAN 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310624", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RIVAROXABAN 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310624", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RIVAROXABAN 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310638", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RIVAROXABAN 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310638", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RIVASTIGMINE 1.5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310665", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RIVASTIGMINE 1.5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310665", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RLCJ PG WCS LV BATTERY ONLY", "code_information": [{"code": "862T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RLCJ PG WCS LV TRNSMTR ONLY", "code_information": [{"code": "863T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RLCJ PULSE GEN ONLY ISDSS", "code_information": [{"code": "681T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC ESP<100", "code_information": [{"code": "69727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14311.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12878.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14311.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC>=100", "code_information": [{"code": "69728", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69726", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14311.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12878.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14311.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV PRSTC MTRL/MESH ABD WALL", "code_information": [{"code": "11008", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 265.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 265.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 265.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 265.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 265.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61892", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV TUNLD CVAD W SQ PORT", "code_information": [{"code": "4916590", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4651.0, "discounted_cash": 3488.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RMV&RPLC PM DUL W/L VNT LEAD", "code_information": [{"code": "C7540", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BATTERY", "code_information": [{"code": "520T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BOTH", "code_information": [{"code": "519T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM LD", "code_information": [{"code": "33288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM PG", "code_information": [{"code": "33287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL & RPL CAR MODULJ PLS GN", "code_information": [{"code": "414T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN 2 LEAD", "code_information": [{"code": "33263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "estimated_discounted_cash": 93104.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN MLT LD", "code_information": [{"code": "33264", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "estimated_discounted_cash": 91622.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT TOT HRT SYS", "code_information": [{"code": "33928", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL ARTIFIC DISC ADDL CRVCL", "code_information": [{"code": "95T", "type": "CPT"}], "standard_charges": [{"minimum": 4200.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62142", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 822.48, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 822.48, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 822.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 822.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 822.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL CAR MODULJ TRANVNS ELT", "code_information": [{"code": "413T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL CARDIAC MODULJ PLS GEN", "code_information": [{"code": "412T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL DEEP RX DELIVERY DEVICE", "code_information": [{"code": "20701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL ESOPHGL SPHNCTR DEV", "code_information": [{"code": "43285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL EXT FIXJ SYS UNDER ANES", "code_information": [{"code": "20694", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL FB UPPER ARM/ELBW DEEP", "code_information": [{"code": "24201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL FB UPPER ARM/ELBW SUBQ", "code_information": [{"code": "24200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 112.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 112.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 112.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 112.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 112.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL HPGLSL NSTIM ARY PG", "code_information": [{"code": "64584", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL I-ARTIC RX DELIVERY DEV", "code_information": [{"code": "20705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL IMED RX DELIVERY DEVICE", "code_information": [{"code": "20703", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL IMPLT VSTIBULAR DEV UNI", "code_information": [{"code": "726T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "447T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL INTACT BREAST IMPLANT", "code_information": [{"code": "19328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8660.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL NINFCT MESH HERNIA RPR", "code_information": [{"code": "49623", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL OF SUBQ DEFIBRILLATOR", "code_information": [{"code": "33272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ LEFT HEART VAD", "code_information": [{"code": "33992", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ RIGHT HEART VAD", "code_information": [{"code": "33997", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BATTERY ONLY", "code_information": [{"code": "518T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BOTH COMPNT", "code_information": [{"code": "861T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM PG ONLY", "code_information": [{"code": "33280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM SYS", "code_information": [{"code": "33278", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33279", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PROSTHHUMRL&ULNAR CMPNT", "code_information": [{"code": "24160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL RPLCMT HRT SYS F/TRNSPL", "code_information": [{"code": "33929", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL RUPTURED BREAST IMPLANT", "code_information": [{"code": "19330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SINUS TARSI IMPLANT", "code_information": [{"code": "510T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SKIN TAGS EA ADDL 10", "code_information": [{"code": "11201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SKIN TAGS UP TO&INC 15", "code_information": [{"code": "11200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 1192.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SS IMPL DFB PG ONLY", "code_information": [{"code": "580T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "4613273", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5815.0, "discounted_cash": 4361.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RMVL SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8655.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL THYRD W/AUTOTRAN PARATH", "code_information": [{"code": "C7555", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL TIS XPNDR WO INSJ IMPLT", "code_information": [{"code": "11971", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 943.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL TONGS/HALO ANTHR INDIV", "code_information": [{"code": "20665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL TOT ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22864", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL TOT ARTHRP 1NTRSPC LMBR", "code_information": [{"code": "22865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1956.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1956.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1956.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1956.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1956.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL& REPLC PULSE GEN 1 LEAD", "code_information": [{"code": "33262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "estimated_discounted_cash": 100376.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL&RIMPLTJ ANT SGM IMPLT", "code_information": [{"code": "661T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14311.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12878.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14311.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL&RINSJ SINUS TARSI IMPLT", "code_information": [{"code": "511T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT IMPLT VSTBLR DEV", "code_information": [{"code": "727T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT SS IMPL DFB PG", "code_information": [{"code": "614T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RN TELEPHONE CALLS TO DMP", "code_information": [{"code": "S0320", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RO- ANAL CANCER", "code_information": [{"code": "M1073", "type": "HCPCS"}, {"code": "5100001", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO- BLADDER CANCER", "code_information": [{"code": "M1075", "type": "HCPCS"}, {"code": "5100002", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-BONE METASTASES", "code_information": [{"code": "M1077", "type": "HCPCS"}, {"code": "5100003", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-BRAIN METASTASES", "code_information": [{"code": "M1079", "type": "HCPCS"}, {"code": "5100004", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-BREAST CANCER", "code_information": [{"code": "M1081", "type": "HCPCS"}, {"code": "5100005", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-CERVICAL CANCER", "code_information": [{"code": "M1085", "type": "HCPCS"}, {"code": "5100007", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-CNS TUMOR", "code_information": [{"code": "M1083", "type": "HCPCS"}, {"code": "5100006", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-COLORECTAL CANCER", "code_information": [{"code": "M1087", "type": "HCPCS"}, {"code": "5100008", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-HEAD/NECK CANCER", "code_information": [{"code": "M1089", "type": "HCPCS"}, {"code": "5100009", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-LUNG CANCER", "code_information": [{"code": "M1095", "type": "HCPCS"}, {"code": "5100010", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-LYMPHOMA", "code_information": [{"code": "M1097", "type": "HCPCS"}, {"code": "5100011", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-PANCREATIC CANCER", "code_information": [{"code": "M1099", "type": "HCPCS"}, {"code": "5100012", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-PROSTATE CANCER", "code_information": [{"code": "M1101", "type": "HCPCS"}, {"code": "5100013", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-UPPER GI CANCER", "code_information": [{"code": "M1103", "type": "HCPCS"}, {"code": "5100014", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RO-UTERINE CANCER", "code_information": [{"code": "M1105", "type": "HCPCS"}, {"code": "5100023", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "ROBOT LIN-RADSURG COM, FIRST", "code_information": [{"code": "G0339", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 60352.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47891.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 60352.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ROBOTIC SURGICAL SYSTEM", "code_information": [{"code": "S2900", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROBT LIN-RADSURG FRACTX 2-5", "code_information": [{"code": "G0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 57137.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23946.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30176.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ROD TEMPLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 209.58, "maximum": 209.58, "gross_charge": 998.0, "discounted_cash": 748.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 209.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROLAPITANT, ORAL, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8670", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.67, "maximum": 1.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"ROPINIROLE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310677", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPINIROLE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310677", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPINIROLE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310678", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROPINIROLE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310678", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROSUVASTATIN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310693", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROSUVASTATIN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310693", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROTAVIRUS ANTIBODY", "code_information": [{"code": "86759", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROTAVIRUS IA", "code_information": [{"code": "87425", "type": "CPT"}, {"code": "4104252", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 363.0, "discounted_cash": 272.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROTAVIRUS IA", "code_information": [{"code": "87425", "type": "CPT"}, {"code": "7256318", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROUT FOOT CARE PER VISIT", "code_information": [{"code": "S0390", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROUTINE FOOTCARE PT W LOPS", "code_information": [{"code": "G0247", "type": "HCPCS"}], "standard_charges": [{"minimum": 557.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ROUTINE OPHTHALMOLOGICAL EXA", "code_information": [{"code": "S0620", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROUTINE OPHTHALMOLOGICAL EXA", "code_information": [{"code": "S0621", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 1", "code_information": [{"code": "78830", "type": "CPT"}], "standard_charges": [{"minimum": 1305.94, "maximum": 2095.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1886.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2095.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2095.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2095.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2095.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 2", "code_information": [{"code": "78832", "type": "CPT"}], "standard_charges": [{"minimum": 1480.34, "maximum": 2377.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2139.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2377.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2377.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2377.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2377.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP QUAN MEAS SINGLE AREA", "code_information": [{"code": "78835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP THERAPY UNLISTED PX", "code_information": [{"code": "79999", "type": "CPT"}], "standard_charges": [{"minimum": 249.62, "maximum": 249.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 249.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 249.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62143", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 966.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 966.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 966.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 966.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 966.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE NO REVJ TRC", "code_information": [{"code": "43762", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3493.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE REVJ GSTRST TRC", "code_information": [{"code": "43763", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLC OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLC PICC NO PRT/PMP W/IMG", "code_information": [{"code": "4546584", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6139.0, "discounted_cash": 4604.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RPLC PICC NO PRT/PMP W/IMG", "code_information": [{"code": "4916584", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6048.0, "discounted_cash": 4536.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RPLC TUNNL CVAD W PORT", "code_information": [{"code": "4916582", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10984.0, "discounted_cash": 8238.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RPLCE TUNL CVAD W SQ PMP", "code_information": [{"code": "4916583", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13590.0, "discounted_cash": 10192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RPLCM OI IMPLT SK TC ESP<100", "code_information": [{"code": "69719", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLCMT A-VALVE TLCJ AUTOL PV", "code_information": [{"code": "33440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLCMT OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69717", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLCMT TISS XPNDR PERM IMPLT", "code_information": [{"code": "11970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST 3-10 NCR/STRN", "code_information": [{"code": "49594", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 37371.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST 3-10 RDC", "code_information": [{"code": "49593", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 41633.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST < 3 CM RDC", "code_information": [{"code": "49591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 28206.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST < 3 NCR/STRN", "code_information": [{"code": "49592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 39985.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST > 10 NCR/STRN", "code_information": [{"code": "49596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST > 10 RDC", "code_information": [{"code": "49595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 83497.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR 3-10 NCR/STRN", "code_information": [{"code": "49616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR 3-10 RDC", "code_information": [{"code": "49615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 80045.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR < 3 NCR/STRN", "code_information": [{"code": "49614", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR < 3 RDC", "code_information": [{"code": "49613", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR > 10 NCR/STRN", "code_information": [{"code": "49618", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR > 10 RDC", "code_information": [{"code": "49617", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA NTRANASL", "code_information": [{"code": "30540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA TRSNPLTN", "code_information": [{"code": "30545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 2.5 CM/<", "code_information": [{"code": "12011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2975.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 2.6-5.0 CM", "code_information": [{"code": "12013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2963.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 5.1-7.5 CM", "code_information": [{"code": "12014", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3140.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 7.6-12.5 CM", "code_information": [{"code": "12015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M >30.0 CM", "code_information": [{"code": "12018", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR FE/E/EN/L/M 12.6-20.0 CM", "code_information": [{"code": "12016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR FE/E/EN/L/M 20.1-30.0 CM", "code_information": [{"code": "12017", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR FEM HERNIA INIT BLOCKED", "code_information": [{"code": "49553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR HERN PREEMIE REDUC", "code_information": [{"code": "49491", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR HYPSPAD COMP DSJ & URTP", "code_information": [{"code": "54348", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR HYPSPAD COMP SIMPLE", "code_information": [{"code": "54340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERN PREMIE BLOCKED", "code_information": [{"code": "49492", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY BLOCKED", "code_information": [{"code": "49496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY REDUC", "code_information": [{"code": "49495", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA INIT BLOCKED", "code_information": [{"code": "49501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA INIT REDUCE", "code_information": [{"code": "49500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH VERMILION ONLY", "code_information": [{"code": "40650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH<HALF VER HEIGHT", "code_information": [{"code": "40652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH>1HALF VER HT/CPX", "code_information": [{"code": "40654", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR NSL VLV COLLAPSE W/IMPLT", "code_information": [{"code": "30468", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR NSL VLV COLLAPSE W/RMDLG", "code_information": [{"code": "30469", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HERNIA RDC", "code_information": [{"code": "49621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HRNA NCR/STRN", "code_information": [{"code": "49622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR PUL ART UNIFOCAL W/O CPB", "code_information": [{"code": "33925", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1921.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1921.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1921.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1921.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1921.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR REM HERNIA INIT REDUCE", "code_information": [{"code": "49550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1370.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/A/GEN/TRK12.6-20.0CM", "code_information": [{"code": "12005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/A/GEN/TRK20.1-30.0CM", "code_information": [{"code": "12006", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3140.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRK7.6-12.5CM", "code_information": [{"code": "12004", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3029.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRNK 2.5CM/<", "code_information": [{"code": "12001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2989.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRNK >30.0 CM", "code_information": [{"code": "12007", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRNK2.6-7.5CM", "code_information": [{"code": "12002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2931.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR SMPL NONFACE 2.6-7.5", "code_information": [{"code": "6909895", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RPR SMPL NONFACE 2.6-7.5", "code_information": [{"code": "6909895", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RPR SMPL NONFACE 7.6-12.", "code_information": [{"code": "6909890", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RPR SMPL NONFACE 7.6-12.", "code_information": [{"code": "6909890", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RPR SMPL NONFACE <2.6CM", "code_information": [{"code": "6909891", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RPR SMPL NONFACE <2.6CM", "code_information": [{"code": "6909891", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RPR TDN/MUSC UPR A/E EACH", "code_information": [{"code": "24341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR&REFIT SPCT PRSTH APHAKIA", "code_information": [{"code": "92371", "type": "CPT"}], "standard_charges": [{"minimum": 20.39, "maximum": 87.06, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87.06, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR&REFITG SPECT XCP APHAKIA", "code_information": [{"code": "92370", "type": "CPT"}], "standard_charges": [{"minimum": 31.99, "maximum": 36.58, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPRDTVE MED RNA GEN PRFL 238", "code_information": [{"code": "253U", "type": "CPT"}], "standard_charges": [{"minimum": 3159.42, "maximum": 3159.42, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3159.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3159.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RRP HYPSPAD COMP MOBLJ&URTP", "code_information": [{"code": "54344", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RSA LOWER EXTR EXAM", "code_information": [{"code": "350T", "type": "CPT"}], "standard_charges": [{"minimum": 80.9, "maximum": 80.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSA SPINE EXAM", "code_information": [{"code": "348T", "type": "CPT"}], "standard_charges": [{"minimum": 108.97, "maximum": 108.97, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSA UPPER EXTR EXAM", "code_information": [{"code": "349T", "type": "CPT"}], "standard_charges": [{"minimum": 108.97, "maximum": 108.97, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSECT HIP TUM INCL FEMUR", "code_information": [{"code": "27078", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 995.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 995.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 995.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 995.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 995.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RSV AMP PROBE", "code_information": [{"code": "87634", "type": "CPT"}, {"code": "4107634", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 70.2, "maximum": 70.2, "gross_charge": 582.0, "discounted_cash": 436.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 70.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 70.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV IA", "code_information": [{"code": "87420", "type": "CPT"}, {"code": "4106414", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 517.0, "discounted_cash": 387.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV MONOC ANTB SEASN .5ML IM", "code_information": [{"code": "90380", "type": "CPT"}], "standard_charges": [{"minimum": 570.59, "maximum": 633.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 570.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 633.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 633.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 633.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 633.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV MONOC ANTB SEASN 1 ML IM", "code_information": [{"code": "90381", "type": "CPT"}], "standard_charges": [{"minimum": 570.59, "maximum": 633.99, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 570.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 633.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 633.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 633.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 633.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV VACC MRNA LIPID NANO IM", "code_information": [{"code": "90683", "type": "CPT"}], "standard_charges": [{"minimum": 313.2, "maximum": 348.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 313.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 348.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 348.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 348.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 348.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV VACC PREF BIVALENT IM", "code_information": [{"code": "90678", "type": "CPT"}], "standard_charges": [{"minimum": 331.34, "maximum": 368.16, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 331.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 368.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 368.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 368.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 368.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV VACC PREF RECOMB ADJT 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"code_information": [{"code": "121", "type": "RC"}], "standard_charges": [{"minimum": 7725.0, "maximum": 7725.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7725.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Ob", "code_information": [{"code": "122", "type": "RC"}], "standard_charges": [{"minimum": 7725.0, "maximum": 7725.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7725.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Oncology", "code_information": [{"code": "127", "type": "RC"}], "standard_charges": [{"minimum": 7725.0, "maximum": 7725.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7725.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Other", "code_information": [{"code": "129", "type": "RC"}], "standard_charges": [{"minimum": 7725.0, "maximum": 7725.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7725.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Pediatric", "code_information": [{"code": "123", "type": "RC"}], "standard_charges": [{"minimum": 7725.0, "maximum": 7725.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7725.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Psychiatric", "code_information": [{"code": "124", "type": "RC"}], "standard_charges": [{"minimum": 902.34, "maximum": 1500.0, "setting": "outpatient", "payers_information": [{"payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS BEHAVIORAL HEALTH COMM", "standard_charge_dollar": 1041.0, "methodology": "per diem"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "standard_charge_dollar": 1421.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 1500.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA SENIOR WHOLE HEALTH MEDICARE ADVANTAGE", "standard_charge_dollar": 902.34, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Rehabilitation", "code_information": [{"code": "128", "type": "RC"}], "standard_charges": [{"minimum": 2369.0, "maximum": 2631.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2369.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2631.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Detoxification", "code_information": [{"code": "156", "type": "RC"}], "standard_charges": [{"minimum": 1421.0, "maximum": 1421.0, "setting": "outpatient", "payers_information": [{"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "standard_charge_dollar": 1421.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward General", "code_information": [{"code": "150", "type": "RC"}], "standard_charges": [{"minimum": 7725.0, "maximum": 7725.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7725.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Medical/Surgical/Gyn", "code_information": [{"code": "151", "type": "RC"}], "standard_charges": [{"minimum": 7725.0, "maximum": 7725.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7725.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Ob", "code_information": [{"code": "152", "type": "RC"}], "standard_charges": [{"minimum": 7725.0, "maximum": 7725.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7725.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Oncology", "code_information": [{"code": "157", "type": "RC"}], "standard_charges": [{"minimum": 7725.0, "maximum": 7725.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7725.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Other", "code_information": [{"code": "159", "type": "RC"}], "standard_charges": [{"minimum": 7725.0, "maximum": 7725.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7725.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Pediatric", "code_information": [{"code": "153", "type": "RC"}], "standard_charges": [{"minimum": 7725.0, "maximum": 7725.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7725.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Psychiatric", "code_information": [{"code": "154", "type": "RC"}], "standard_charges": [{"minimum": 902.34, "maximum": 1500.0, "setting": "outpatient", "payers_information": [{"payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS BEHAVIORAL HEALTH COMM", "standard_charge_dollar": 1041.0, "methodology": "per diem"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "standard_charge_dollar": 1421.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 1500.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA SENIOR WHOLE HEALTH MEDICARE ADVANTAGE", "standard_charge_dollar": 902.34, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Rehabilitation", "code_information": [{"code": "158", "type": "RC"}], "standard_charges": [{"minimum": 2369.0, "maximum": 2631.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2369.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2631.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Rpr intst excl anrect fist", "code_information": [{"code": "C9796", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "S BOWEL ENDOSCOPE W/STENT", "code_information": [{"code": "44379", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "S&I STENT/CHEST VERT ART", "code_information": [{"code": "76T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SACITUZUMAB GOVITECAN-HZIY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9317", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.65, "maximum": 36.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 36.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SACROILIAC JOINTS 2 VWS", "code_information": [{"code": "72200", "type": "CPT"}, {"code": "4902200", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 231.0, "gross_charge": 1100.0, "discounted_cash": 825.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], 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{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 683.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 683.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 683.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 683.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 683.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS HIGH 50", "code_information": [{"code": "99233", "type": "CPT"}], "standard_charges": [{"minimum": 95.86, "maximum": 95.86, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 95.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 95.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 95.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 95.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 95.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS MODERATE 35", "code_information": [{"code": "99232", "type": "CPT"}], "standard_charges": [{"minimum": 67.07, "maximum": 67.07, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 67.07, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 67.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 67.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 67.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 67.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS SF/LOW 25", "code_information": [{"code": "99231", "type": "CPT"}], "standard_charges": [{"minimum": 37.43, "maximum": 37.43, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NB EM PER DAY HOSP", "code_information": [{"code": "99462", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE HIGH MDM 45", "code_information": [{"code": "99310", "type": "CPT"}], "standard_charges": [{"minimum": 120.38, "maximum": 120.38, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 120.38, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 120.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 120.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 120.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 120.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE LOW MDM 20", "code_information": [{"code": "99308", "type": "CPT"}], "standard_charges": [{"minimum": 61.98, "maximum": 61.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE MODERATE MDM 30", "code_information": [{"code": "99309", "type": "CPT"}], "standard_charges": [{"minimum": 82.8, "maximum": 82.8, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 82.8, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 82.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 82.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 82.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 82.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE SF MDM 10", "code_information": [{"code": "99307", "type": "CPT"}], "standard_charges": [{"minimum": 40.2, "maximum": 40.2, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.2, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQT PLMT DRUG ELUT OC INS", "code_information": [{"code": "445T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6694.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SC DIS P-SELECTIN WHL BLOOD", "code_information": [{"code": "122U", "type": "CPT"}], "standard_charges": [{"minimum": 526.23, "maximum": 526.23, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 526.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 526.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC DIS VCAM-1 WHOLE BLOOD", "code_information": [{"code": "121U", "type": "CPT"}], "standard_charges": [{"minimum": 509.2, "maximum": 509.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 509.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 509.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC GNOTYP ERMAP EXONS 4 12", "code_information": [{"code": "199U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION RESET PUMP", "code_information": [{"code": "96371", "type": "CPT"}], "standard_charges": [{"minimum": 81.38, "maximum": 93.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCALING GINGIV INFLAMMATION", "code_information": [{"code": "D4346", "type": "HCPCS"}], "standard_charges": [{"minimum": 249.51, "maximum": 285.34, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 256.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 249.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 285.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 285.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 285.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCAN HEMO COMP PREOP BI STDY", "code_information": [{"code": "93985", "type": "CPT"}, {"code": "4633985", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 304.17, "maximum": 347.84, "gross_charge": 2026.0, "discounted_cash": 1519.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 313.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 304.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 347.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 347.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 347.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCAN HEMO COMP PREOP UNI STD", "code_information": [{"code": "93986", "type": "CPT"}, {"code": "4633986", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 146.3, "maximum": 167.31, "gross_charge": 974.0, "discounted_cash": 730.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 150.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 146.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 167.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 167.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 167.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCAN HEMODIALYSIS ACCESS", "code_information": [{"code": "93990", "type": "CPT"}, {"code": "4637014", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 153.23, "maximum": 228.52, "gross_charge": 990.0, "discounted_cash": 742.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 228.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 157.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 153.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 228.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 228.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 228.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 228.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCAN PROC CRANIAL EXTRA", "code_information": [{"code": "61782", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCAN PROC CRANIAL INTRA", "code_information": [{"code": "61781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCAN PROC SPINAL", "code_information": [{"code": "61783", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCAPULA COMPLETE", "code_information": [{"code": "73010", "type": "CPT"}, {"code": "4903010", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 177.03, "gross_charge": 843.0, "discounted_cash": 632.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 177.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 33.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 33.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 33.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 33.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 33.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCAPULA COMPLETE", "code_information": [{"code": "73010", "type": "CPT"}, {"code": "5013010", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 177.03, "gross_charge": 843.0, "discounted_cash": 632.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 177.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 33.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 33.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 33.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 33.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 33.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCINTIMAMMOGRAPHY", "code_information": [{"code": "S8080", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCLERAL LENS LIQUID BANDAGE", "code_information": [{"code": "S0515", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SCLEROTHERAPY FLUID COLL", "code_information": [{"code": "4919186", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 15243.0, "discounted_cash": 11432.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCLEROTX FLUID COLLECTION", "code_information": [{"code": "49185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCOPE PLANTAR FASCIOTOMY", "code_information": [{"code": "29893", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO, AUTOMATED SYS", "code_information": [{"code": "G0147", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO, AUTOSYS, RESCR", "code_information": [{"code": "G0148", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 77.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 77.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,AUTOSYS AND MD", "code_information": [{"code": "G0141", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 84.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 84.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,THINLAYER,RESCR", "code_information": [{"code": "G0143", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 103.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 103.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.05, "methodology": "fee schedule"}], "billing_class": 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"RC"}], "standard_charges": [{"minimum": 444.36, "maximum": 444.36, "gross_charge": 2116.0, "discounted_cash": 1587.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 444.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCRW TWIST-OFF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 244.86, "maximum": 244.86, "gross_charge": 1166.0, "discounted_cash": 874.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 244.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEALANT REPAIR PER TOOTH", "code_information": [{"code": "D1353", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.99, "maximum": 33.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 28.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEALANT, PULMONARY, LIQUID", "code_information": [{"code": "C2615", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEC ART THROMBECTOMY ADD-ON", "code_information": [{"code": "37186", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEC CLSR SURG WND/DEHSN XTN", "code_information": [{"code": "13160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEDATIVE HYPNOTICS", "code_information": [{"code": "80368", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEDIMENTN RATE-NON-AUTO", "code_information": [{"code": "85651", "type": "CPT"}, {"code": "4105651", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.1, "gross_charge": 153.0, "discounted_cash": 114.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 18.1, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEG ACET AND ETH ESTR YEARLY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7294", "type": "HCPCS"}], "standard_charges": [{"minimum": 2483.49, "maximum": 2759.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2483.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2759.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2759.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2759.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2759.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEGMENTECTOMY", "code_information": [{"code": "32484", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1437.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1437.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1437.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1437.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1437.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEIZURES WITH MCC", "code_information": [{"code": "100", "type": "MS-DRG"}], "standard_charges": [{"minimum": 64305.63, "maximum": 81033.78, "estimated_discounted_cash": 66583.84, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64305.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 81033.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEIZURES WITHOUT MCC", "code_information": [{"code": "101", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29968.13, "maximum": 37763.88, "estimated_discounted_cash": 59894.04, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29968.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37763.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEL DEB 1ST 20CM OR LESS", "code_information": [{"code": "97597", "type": "CPT"}, {"code": "6704284", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "gross_charge": 339.0, "discounted_cash": 254.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 247.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 240.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEL DEB 1ST 20CM OR LESS", "code_information": [{"code": "97597", "type": "CPT"}, {"code": "6727597", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 4200.0, "gross_charge": 339.0, "discounted_cash": 254.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 247.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 240.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 274.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 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schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 90.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 87.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 100.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 100.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 100.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENT LYMPH NODE BIOPSY", "code_information": [{"code": "G8878", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEPARATE EYELID ADHESIONS", "code_information": [{"code": "68340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 837.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPT9 GEN PRMTR MTHYLTN ALYS", "code_information": [{"code": "81327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 311.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 311.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH CC", "code_information": [{"code": "549", "type": "MS-DRG"}], "standard_charges": [{"minimum": 40081.45, "maximum": 50508.04, "estimated_discounted_cash": 16763.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 40081.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 50508.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH MCC", "code_information": [{"code": "548", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5930.61, "maximum": 80786.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8346.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 28913.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 66016.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17307.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8782.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 69464.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18211.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30423.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 32126.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19230.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9273.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 73351.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 32126.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 73351.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19230.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9273.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 73351.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 32126.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9273.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19230.74, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 49712.25, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11018.47, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5930.61, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 18183.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64109.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80786.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITHOUT CC/MCC", "code_information": [{"code": "550", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29021.87, "maximum": 36571.47, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29021.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36571.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS", "code_information": [{"code": "870", "type": "MS-DRG"}], "standard_charges": [{"minimum": 229485.58, "maximum": 289182.8, "estimated_discounted_cash": 218566.78, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 229485.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 289182.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [{"code": "871", "type": "MS-DRG"}], "standard_charges": [{"minimum": 64494.88, "maximum": 81272.26, "estimated_discounted_cash": 90860.35, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64494.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 81272.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC", "code_information": [{"code": "872", "type": "MS-DRG"}], "standard_charges": [{"minimum": 33975.61, "maximum": 42813.85, "estimated_discounted_cash": 64711.41, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33975.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42813.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY OLECRN PROCES", "code_information": [{"code": "24138", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY RADIAL H/N", "code_information": [{"code": "24136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY SHFT/DSTL HUM", "code_information": [{"code": "24134", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SERIAL SALIVARY IMAGING", "code_information": [{"code": "78231", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 397.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 397.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 164.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 164.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 164.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 164.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 164.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERIAL TONOMETRY", "code_information": [{"code": "92100", "type": "CPT"}], "standard_charges": [{"minimum": 91.39, "maximum": 91.39, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 91.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 91.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 91.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 91.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 91.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERMORELIN ACETATE INJECTION", "code_information": [{"code": "Q0515", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.62, "maximum": 1.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER 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NETWORK WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEROTONIN/2", "code_information": [{"code": "84260", "type": "CPT"}, {"code": "7254261", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 157.97, "gross_charge": 473.0, "discounted_cash": 354.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 157.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERPINA1 COMMON VARIANTS", "code_information": [{"code": "81332", "type": "CPT"}, {"code": "7259212", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 222.94, "gross_charge": 408.0, "discounted_cash": 306.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 222.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERTRALINE", "code_information": [{"code": "80332", "type": "CPT"}, {"code": "7258224", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 204.0, "discounted_cash": 153.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERTRALINE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310761", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SERTRALINE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310761", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SERTRALINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310759", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SERTRALINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310759", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SERTRALINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310760", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SERTRALINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310760", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SERUM CLOTTING TIME TUBE", "code_information": [{"code": "A4771", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERUM IMMUNOELECTROPHORESIS", "code_information": [{"code": "86320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 114.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 114.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 31.32, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 31.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 31.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 31.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 31.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERV PART OF PHASE I TRIAL", "code_information": [{"code": "S9988", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERVICES OUTSIDE US", "code_information": [{"code": "S9989", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERVICES PROVIDED AS PART OF", "code_information": [{"code": "S9990", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERVICES PROVIDED AS PART OF", "code_information": [{"code": "S9991", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERVICES PROVIDED IN URGENT", "code_information": [{"code": "S9088", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SET UP PORT XRAY EQUIPMENT", "code_information": [{"code": "Q0092", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET-UP CARDIOVERT-DEFIBRILL", "code_information": [{"code": "93745", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEVELAMER 800MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310764", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SEVELAMER 800MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310764", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SEVELAMER CARB 800MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310765", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SEVELAMER CARB 800MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310765", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SEVER CRANIAL NERVE", "code_information": [{"code": "64771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 40.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX HORMONE BIND GLOBULN", "code_information": [{"code": "84270", "type": "CPT"}, {"code": "7254270", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 110.81, "gross_charge": 512.0, "discounted_cash": 384.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 110.81, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.36, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX TRANSFORMATION F TO M", "code_information": [{"code": "55980", "type": "CPT"}], "standard_charges": [{"minimum": 7835.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEX TRANSFORMATION M TO F", "code_information": [{"code": "55970", "type": "CPT"}], "standard_charges": [{"minimum": 7835.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SF3B1 GENE COMMON VARIANTS", "code_information": [{"code": "81347", "type": "CPT"}], "standard_charges": [{"minimum": 193.25, "maximum": 193.25, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 193.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 193.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SGMDSC W/BAND LIGATION", "code_information": [{"code": "45350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11311", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11302", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 66.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHEATH STEERABLE TOURGUIDE", "code_information": [{"code": "C1766", "type": "HCPCS"}, {"code": "8177128", "type": "CDM"}], "standard_charges": [{"minimum": 694.26, "maximum": 694.26, "gross_charge": 3306.0, "discounted_cash": 2479.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 694.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHEATH URETERAL ACCESS", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8041028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 120.12, "maximum": 120.12, "gross_charge": 572.0, "discounted_cash": 429.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 120.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHIGA-TOXIN IA", "code_information": [{"code": "87427", "type": "CPT"}, {"code": "4106634", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 320.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHIGELLA ANTIBODY", "code_information": [{"code": "86771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS DX +- SYNOVIAL BX", "code_information": [{"code": "29805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG BICP TENODSIS", "code_information": [{"code": "29828", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 20603.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG CAPSULORRAPHY", "code_information": [{"code": "29806", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 30332.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG COMPL SYNVCT", "code_information": [{"code": "29821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG DECOMPRESSION", "code_information": [{"code": "29826", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7942.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG DSTL CLAVICLC", "code_information": [{"code": "29824", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 18159.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG LMTD DBRDMT", "code_information": [{"code": "29822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7942.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG LSS&RESCJ ADS", "code_information": [{"code": "29825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 46606.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG PRTL SYNVCT", "code_information": [{"code": "29820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG RMVL LOOSE/FB", "code_information": [{"code": "29819", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG RPR SLAP LES", "code_information": [{"code": "29807", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG RT8TR CUF RPR", "code_information": [{"code": "29827", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 20018.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG XTNSV DBRDMT", "code_information": [{"code": "29823", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOE HEEL PAD REMOVABLE FOR", "code_information": [{"code": "L3485", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.57, "maximum": 26.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 26.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 26.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 26.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS & ULNA", "code_information": [{"code": "25392", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS OR ULNA", "code_information": [{"code": "25390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHORTEN/LENGTHEN THIGHS", "code_information": [{"code": "27468", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1317.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1317.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1317.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1317.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1317.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF HAND TENDON", "code_information": [{"code": "26479", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF THIGH BONE", "code_information": [{"code": "27465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1176.18, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1176.18, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1176.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1176.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1176.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER 2 VWS MINIMUM", "code_information": [{"code": "73030", "type": "CPT"}, {"code": "4903030", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 343.98, "gross_charge": 1638.0, "discounted_cash": 1228.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 343.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER 2 VWS MINIMUM", "code_information": [{"code": "73030", "type": "CPT"}, {"code": "5013030", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 343.98, "gross_charge": 1638.0, "discounted_cash": 1228.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 343.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER ARTHROGRAPHY", "code_information": [{"code": "73040", "type": "CPT"}, {"code": "4903040", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 638.61, "gross_charge": 3041.0, "discounted_cash": 2280.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 638.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 273.47, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 127.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 127.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 127.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 127.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 127.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER ARTHROGRAPHY", "code_information": [{"code": "73040", "type": "CPT"}, {"code": "4913040", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 638.61, "gross_charge": 3041.0, "discounted_cash": 2280.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 638.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 273.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 127.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 127.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 127.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 127.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 127.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER JOINT SURGERY", "code_information": [{"code": "23101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23334", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER SINGLE VIEW", "code_information": [{"code": "73020", "type": "CPT"}, {"code": "4903020", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 129.78, "gross_charge": 618.0, "discounted_cash": 463.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 129.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.95, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER SINGLE VIEW", "code_information": [{"code": "73020", "type": "CPT"}, {"code": "5013020", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 129.78, "gross_charge": 618.0, "discounted_cash": 463.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 129.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.11, "methodology": "fee 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"discounted_cash": 193.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 48.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIALODOCHOPLASTY", "code_information": [{"code": "D7982", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIALOGRAPHY", "code_information": [{"code": "70390", "type": "CPT"}, {"code": "4900390", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 554.82, "gross_charge": 2642.0, "discounted_cash": 1981.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 554.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 247.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIALOGRAPHY", "code_information": [{"code": "70390", "type": "CPT"}, {"code": "4910390", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 554.82, "gross_charge": 2642.0, "discounted_cash": 1981.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 554.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 247.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SICKLING OF RBC", "code_information": [{"code": "85660", "type": "CPT"}, {"code": "4103052", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.14, "gross_charge": 183.0, "discounted_cash": 137.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 28.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SICKLING OF RBC", "code_information": [{"code": "85660", "type": "CPT"}, {"code": "7143052", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.14, "gross_charge": 183.0, "discounted_cash": 137.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 28.14, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SICKLING OF RBC", "code_information": [{"code": "85660", "type": "CPT"}, {"code": "7255660", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.14, "gross_charge": 32.0, "discounted_cash": 24.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 28.14, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIG W/TNDSC BALLOON DILATION", "code_information": [{"code": "45340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8569.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY & DECOMPRESS", "code_information": [{"code": "45337", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY & POLYPECTOMY", "code_information": [{"code": "45333", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY AND BIOPSY", "code_information": [{"code": "45331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8389.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY FOR BLEEDING", "code_information": [{"code": "45334", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ABLATION", "code_information": [{"code": "45346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/FB REMOVAL", "code_information": [{"code": "45332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8487.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/PLCMT STENT", "code_information": [{"code": "45347", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/RESECTION", "code_information": [{"code": "45349", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/SUBMUC INJ", "code_information": [{"code": "45335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9251.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 227.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/TUMR REMOVE", "code_information": [{"code": "45338", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8269.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ULTRASOUND", "code_information": [{"code": "45341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9251.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/US GUIDE BX", "code_information": [{"code": "45342", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8487.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 388.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "555", "type": "MS-DRG"}], "standard_charges": [{"minimum": 43886.4, "maximum": 55302.79, "estimated_discounted_cash": 53175.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43886.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55302.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC", "code_information": [{"code": "556", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27577.58, "maximum": 34751.47, "estimated_discounted_cash": 41898.53, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27577.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34751.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [{"code": "947", "type": "MS-DRG"}], "standard_charges": [{"minimum": 42146.62, "maximum": 53110.43, "estimated_discounted_cash": 50796.54, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42146.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 53110.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "948", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26578.2, "maximum": 33492.12, "estimated_discounted_cash": 71017.39, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26578.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33492.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SILDENAFIL 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310777", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SILDENAFIL 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310777", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SILDENAFIL CITRATE, 25 MG", "code_information": [{"code": "S0090", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.27, "maximum": 0.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILICA", "code_information": [{"code": "84285", "type": "CPT"}, {"code": "7254285", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 120.09, "gross_charge": 983.0, "discounted_cash": 737.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 120.09, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILICONE GEL SHEET, EACH", "code_information": [{"code": "A6025", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIMPLE CYSTOMETROGRAM", "code_information": [{"code": "51725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 136.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [{"code": "194", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5453.14, "maximum": 33718.05, "estimated_discounted_cash": 54176.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9718.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12755.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 17643.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26745.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13421.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10226.27, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 28142.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18565.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29717.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 19604.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14173.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10798.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14173.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29717.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 19604.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10798.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10798.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29717.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 19604.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14173.17, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", 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"methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 16685.55, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7929.23, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 20055.28, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 12283.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43640.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 54993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC", "code_information": [{"code": "195", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20867.46, "maximum": 26295.81, "estimated_discounted_cash": 51459.42, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20867.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26295.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMULT PANC KIDN TRANS", "code_information": [{"code": "S2065", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 83791.71, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 100147.66, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 74910.17, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 50725.91, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 89945.43, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 182445.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 186083.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 234490.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS", "code_information": [{"code": "19", "type": "MS-DRG"}], "standard_charges": [{"minimum": 236882.99, "maximum": 298504.53, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 236882.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 298504.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMVASTATIN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310791", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, 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"setting": "both", "billing_class": "facility"}]}, {"description": "SINGL PRSCRP LENS", "code_information": [{"code": "S0504", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SINGLE ENERGY X-RAY STUDY", "code_information": [{"code": "G0130", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 175.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 96.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 157.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 153.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL", "code_information": [{"code": "402", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 168213.7, "estimated_discounted_cash": 329341.08, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 133488.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 168213.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE", "code_information": [{"code": "450", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 222985.13, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 176953.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 222985.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC", "code_information": [{"code": "451", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 135156.71, "estimated_discounted_cash": 263835.98, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 107255.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 135156.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINGLE TRANSFER TOE-HAND", "code_information": [{"code": "26553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2861.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2861.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2861.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2861.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2861.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUS AND MASTOID PROCEDURES WITH CC/MCC", "code_information": [{"code": "135", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6402.87, "maximum": 90790.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15183.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36692.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13047.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21780.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13729.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22918.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 38609.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15976.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14497.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 40770.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24200.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16870.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16870.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40770.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14497.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24200.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16870.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40770.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14497.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24200.75, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 20808.02, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6402.87, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 7539.16, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 11240.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 72048.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 90790.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "136", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6575.07, "maximum": 42479.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11333.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 31606.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 22295.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 15683.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16502.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 23460.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11925.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33257.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 35118.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 24773.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12592.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 17425.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 17425.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12592.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 24773.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 35118.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 24773.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12592.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 35118.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 17425.99, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6575.07, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8589.34, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13550.65, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 22141.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33709.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42479.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUS AUG W BONE OR BONE SUB", "code_information": [{"code": "D7951", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSES 2VW MAX", "code_information": [{"code": "70210", "type": "CPT"}, {"code": "4900210", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 155.82, "gross_charge": 742.0, "discounted_cash": 556.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 155.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 79.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSES 2VW MAX", "code_information": [{"code": "70210", "type": "CPT"}, {"code": "5010210", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 155.82, "gross_charge": 742.0, "discounted_cash": 556.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 155.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 79.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSES 3VW MIN", "code_information": [{"code": "70220", "type": "CPT"}, {"code": "5010220", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 294.0, "gross_charge": 1400.0, "discounted_cash": 1050.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 99.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 47.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSOIDAL ROTATIONAL TEST", "code_information": [{"code": "92546", "type": "CPT"}], "standard_charges": [{"minimum": 98.25, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIPULEUCEL-T AUTO CD54+", "code_information": [{"code": "Q2043", "type": "HCPCS"}], "standard_charges": [{"minimum": 49745.09, "maximum": 55272.32, "setting": "outpatient", 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"standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SITAGLIPTIN 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310796", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 71.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SITAGLIPTIN 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310796", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 71.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SITE NOT SMALL CELL LUNG CA", "code_information": [{"code": "G9285", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKEL MUSC RELAXANT 3 OR MORE", "code_information": [{"code": "80370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKELETAL MUSC RELXNT 1-2", "code_information": [{"code": "80369", "type": "CPT"}, {"code": "7250024", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 928.0, "discounted_cash": 696.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN AND 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{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITH CC", "code_information": [{"code": "571", "type": "MS-DRG"}], "standard_charges": [{"minimum": 56094.78, "maximum": 70686.99, "estimated_discounted_cash": 89165.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 56094.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 70686.99, "methodology": "case rate"}], "billing_class": 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"standard_charge_dollar": 162729.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 205061.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC", "code_information": [{"code": "578", "type": "MS-DRG"}], "standard_charges": [{"minimum": 53335.69, "maximum": 67210.17, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 53335.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 67210.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [{"code": "574", "type": "MS-DRG"}], "standard_charges": [{"minimum": 115257.42, "maximum": 145239.9, "estimated_discounted_cash": 89917.6, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 115257.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 145239.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [{"code": "573", "type": "MS-DRG"}], "standard_charges": [{"minimum": 217519.58, "maximum": 274104.02, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 217519.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274104.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC", "code_information": [{"code": "575", "type": "MS-DRG"}], "standard_charges": [{"minimum": 59663.99, "maximum": 75184.68, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 59663.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 75184.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [{"code": "623", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14933.5, "maximum": 80598.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 59816.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 72538.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27185.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16759.66, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17635.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 76326.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 28605.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 62941.29, 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66463.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18622.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 80598.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 66463.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18622.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30206.62, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 28244.11, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": 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"methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 83167.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 45099.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30153.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 51146.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 87821.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 87821.96, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 51146.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30153.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 45099.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 45099.55, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51146.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30153.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 87821.96, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 39972.27, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 69780.57, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 34586.97, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 24587.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 118172.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 148913.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "624", "type": "MS-DRG"}], "standard_charges": [{"minimum": 41565.58, "maximum": 52378.24, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41565.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 52378.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITH CC/MCC", "code_information": [{"code": "904", "type": "MS-DRG"}], "standard_charges": [{"minimum": 121954.27, "maximum": 153678.83, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 121954.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 153678.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "905", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49251.85, "maximum": 62063.97, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49251.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 62063.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN PEDICLE FLAP ARMS/LEGS", "code_information": [{"code": "15572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN PEDICLE FLAP TRUNK", "code_information": [{"code": "15570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN PEEL THERAPY", "code_information": [{"code": "17360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SPLT GRFT T/A/L ADD-ON", "code_information": [{"code": "15101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SPLT GRFT TRNK/ARM/LEG", "code_information": [{"code": "15100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT F/N/HF/G ADDL", "code_information": [{"code": "15276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT FACE/NK/HF/G", "code_information": [{"code": "15275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5813.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT T/A/L ADD-ON", "code_information": [{"code": "15272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT TRNK/ARM/LEG", "code_information": [{"code": "15271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6067.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRFT T/ARM/LG CHILD", "code_information": [{"code": "15273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6213.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN TEST CANDIDA", "code_information": [{"code": "86485", "type": "CPT"}], "standard_charges": [{"minimum": 24.67, "maximum": 24.67, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TEST UNLISTED ANTIGN EA", "code_information": [{"code": "86486", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TST PPD TB 5T.U", "code_information": [{"code": "86580", "type": "CPT"}, {"code": "6706580", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.57, "gross_charge": 136.0, "discounted_cash": 102.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH CC", "code_information": [{"code": "593", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2737.0, "maximum": 338985.63, "estimated_discounted_cash": 47034.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 196189.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2879.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 155498.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 305083.9, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3029.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 206436.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 321018.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 163620.25, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 172777.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3199.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 217990.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 338985.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 338985.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 172777.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 217990.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3199.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 172777.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 338985.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3199.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 217990.43, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 190511.44, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 148400.97, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 114866.79, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 2737.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39387.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49633.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH MCC", "code_information": [{"code": "592", "type": "MS-DRG"}], "standard_charges": [{"minimum": 64255.83, "maximum": 80971.02, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64255.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80971.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITHOUT CC/MCC", "code_information": [{"code": "594", "type": "MS-DRG"}], "standard_charges": [{"minimum": 28779.49, "maximum": 36266.05, "estimated_discounted_cash": 47034.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28779.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36266.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SPLT A-GRFT F/N/HF/G ADD", "code_information": [{"code": "15121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SPLT A-GRFT FAC/NCK/HF/G", "code_information": [{"code": "15120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT F/N/HF/G CH ADD", "code_information": [{"code": "15278", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT F/N/HF/G CHILD", "code_information": [{"code": "15277", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5035.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT T/A/L CHILD ADD", "code_information": [{"code": "15274", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKULL 4VW MIN", "code_information": [{"code": "70260", "type": "CPT"}, {"code": "4900260", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 303.03, "gross_charge": 1443.0, "discounted_cash": 1082.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 303.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 114.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKULL 4VW MIN", "code_information": [{"code": "70260", "type": "CPT"}, {"code": "5010260", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 303.03, "gross_charge": 1443.0, "discounted_cash": 1082.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 303.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 114.16, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKULL < 4 VIEWS", "code_information": [{"code": "70250", "type": "CPT"}, {"code": "4900250", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 244.44, "gross_charge": 1164.0, "discounted_cash": 873.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKULL < 4 VIEWS", "code_information": [{"code": "70250", "type": "CPT"}, {"code": "5010250", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 244.44, "gross_charge": 1164.0, "discounted_cash": 873.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.78, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKULL BASE/BRAINSTEM SURGERY", "code_information": [{"code": "61575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2226.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2226.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2226.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2226.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2226.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKULL BASE/BRAINSTEM SURGERY", "code_information": [{"code": "61576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3495.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3495.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3495.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3495.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3495.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKYLA, 13.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7301", "type": "HCPCS"}], "standard_charges": [{"minimum": 1037.68, "maximum": 1152.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1037.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1152.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1152.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1152.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1152.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLCO1B1 GENE COM VARIANTS", "code_information": [{"code": "81328", "type": "CPT"}], "standard_charges": [{"minimum": 174.81, "maximum": 174.81, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLED ULNAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 468.3, "maximum": 468.3, "gross_charge": 2230.0, "discounted_cash": 1672.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 468.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEP APNEA ASSESS", "code_information": [{"code": "G8839", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLEEP STUDY ATTENDED", "code_information": [{"code": "95807", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1942.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1942.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 627.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 627.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 627.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 627.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 627.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEP STUDY UNATTEND", "code_information": [{"code": "95806", "type": "CPT"}, {"code": "4806100", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 536.59, "gross_charge": 2208.0, "discounted_cash": 1656.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 536.59, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 235.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 235.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 235.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 235.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 235.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE LOBECTOMY", "code_information": [{"code": "32486", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2208.47, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2208.47, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2208.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2208.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2208.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLEEVE PNEUMONECTOMY", "code_information": [{"code": "32442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2811.02, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2811.02, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2811.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2811.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2811.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLING ARM FASHON", "code_information": [{"code": "A4565", "type": "HCPCS"}, {"code": "8114445", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"minimum": 249.0, "maximum": 249.0, "gross_charge": 249.0, "discounted_cash": 186.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING URETH STRATASIS 20", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "8243060", "type": "CDM"}], "standard_charges": [{"minimum": 2095.8, "maximum": 2095.8, "gross_charge": 9980.0, "discounted_cash": 7485.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 17320.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLNG URETH SUPPORT", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "4024700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1488.06, "maximum": 1488.06, "gross_charge": 7086.0, "discounted_cash": 5314.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1488.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLNG URETH SUPPORT LYNX BLUE", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "4024702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1488.06, "maximum": 1488.06, "gross_charge": 7086.0, "discounted_cash": 5314.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1488.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLP STDY UNATND W/ANAL", "code_information": [{"code": "95801", "type": "CPT"}], "standard_charges": [{"minimum": 145.03, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLP STDY UNATND W/HRT/O2/RESP", "code_information": [{"code": "95800", "type": "CPT"}, {"code": "4805801", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 185.16, "maximum": 458.64, "gross_charge": 1638.0, "discounted_cash": 1228.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 458.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLP STDY UNATND W/HRT/O2/RESP", "code_information": [{"code": "95800", "type": "CPT"}, {"code": "6915800", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 185.16, "maximum": 336.56, "gross_charge": 1202.0, "discounted_cash": 901.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 336.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SM 153 LEXIDRONAM", "code_information": [{"code": "A9604", "type": "HCPCS"}], "standard_charges": [{"minimum": 16706.24, "maximum": 18562.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16706.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18562.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18562.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18562.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18562.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SM BOWEL SNGL CM STDY", "code_information": [{"code": "74250", "type": "CPT"}, {"code": "4904250", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 536.55, "gross_charge": 2555.0, "discounted_cash": 1916.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 536.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 200.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 109.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 109.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 109.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 109.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 109.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SM INT IMAGE CAP PROC", "code_information": [{"code": "91110", "type": "CPT"}, {"code": "5070262", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1186.14, "gross_charge": 7910.0, "discounted_cash": 5932.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1067.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1037.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1186.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1186.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1186.14, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL ANIMAL INOCULATION", "code_information": [{"code": "87003", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 85.85, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7562.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44363", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44364", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44366", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44369", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 11209.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44372", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44373", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44376", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44378", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44384", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY BR/WA", "code_information": [{"code": "44380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY BR/WA", "code_information": [{"code": "44381", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/BIOPSY", "code_information": [{"code": "44361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9200.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/BIOPSY", "code_information": [{"code": "44377", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5604.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/STENT", "code_information": [{"code": "44370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1116.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL DISPOSABLE UNDERPAD", "code_information": [{"code": "T4542", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALLPOX&MONKEYPOX VAC 0.5ML", "code_information": [{"code": "90611", "type": "CPT"}], "standard_charges": [{"minimum": 291.6, "maximum": 324.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 291.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 324.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 324.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 324.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 324.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMEAR FLUORESCENT/AFS", "code_information": [{"code": "87206", "type": "CPT"}, {"code": "4107201", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.38, "gross_charge": 275.0, "discounted_cash": 206.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27.38, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMEAR FLUORESCENT/AFS", "code_information": [{"code": "87206", "type": "CPT"}, {"code": "7257198", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.38, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMEAR FLUORESCENT/AFS/2", "code_information": [{"code": "87206", "type": "CPT"}, {"code": "4147204", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.38, "gross_charge": 275.0, "discounted_cash": 206.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMEAR SALINE/INK/KOH", "code_information": [{"code": "87210", "type": "CPT"}, {"code": "4107215", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.75, "gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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NETWORK WC", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOMATREM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2940", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.06, "maximum": 42.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 38.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 42.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 42.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 42.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 42.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOMATROPIN PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2941", "type": "HCPCS"}, {"code": "5324303", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 159.49, "maximum": 177.21, "gross_charge": 317.0, "discounted_cash": 237.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 159.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 177.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 177.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 177.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 177.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOMATROPIN PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2941", "type": "HCPCS"}, {"code": "5324303", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 159.49, "maximum": 177.21, "gross_charge": 317.0, "discounted_cash": 237.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 159.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 177.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 177.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 177.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 177.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOTALOL 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310870", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SOTALOL 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310870", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SOTALOL AF 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310876", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SOTALOL AF 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310876", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SOTALOL HYDROCHLORIDE IV", "code_information": [{"code": "C9482", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.78, "maximum": 27.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP ANT CERVICAL PLT L1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1431.15, "maximum": 1431.15, "gross_charge": 6815.0, "discounted_cash": 5111.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1431.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP ANT CERVICAL PLT L2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1431.15, "maximum": 1431.15, "gross_charge": 6815.0, "discounted_cash": 5111.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1431.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP ANT CERVICAL PLT L3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1506.12, "maximum": 1506.12, "gross_charge": 7172.0, "discounted_cash": 5379.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1506.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP ANTERIOR SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 589.05, "maximum": 589.05, "gross_charge": 2805.0, "discounted_cash": 2103.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 589.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP APHASIA EVAL PER HOUR", "code_information": [{"code": "96105", "type": "CPT"}, {"code": "5900810", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 1202.0, "discounted_cash": 901.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP APHASIA EVAL PER HOUR", "code_information": [{"code": "96105", "type": "CPT"}, {"code": "6056105", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1381.0, "discounted_cash": 1035.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP BEHV+QUAL ANAL+V/RS-TELEMED", "code_information": [{"code": "92524", "type": "CPT"}, {"code": "5902520", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 419.0, "discounted_cash": 314.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN|95"}, {"description": "SP BEHV+QUAL ANAL+V/RS-TELEMED", "code_information": [{"code": "92524", "type": "CPT"}, {"code": "6052519", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 419.0, "discounted_cash": 314.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN|95"}, {"description": "SP BN GRAFT ALLOGRAFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.32, "maximum": 313.32, "gross_charge": 1492.0, "discounted_cash": 1119.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 313.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP BONE AGRFT LOCAL ADD-ON", "code_information": [{"code": "20936", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7357.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SP BONE AGRFT MORSEL ADD-ON", "code_information": [{"code": "20937", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 169.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 169.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 169.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 169.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 169.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SP BONE AGRFT STRUCT ADD-ON", "code_information": [{"code": "20938", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 184.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 184.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 184.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 184.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 184.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SP BONE ALGRFT MORSEL ADD-ON", "code_information": [{"code": "20930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 8649.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SP BONE ALGRFT STRUCT ADD-ON", "code_information": [{"code": "20931", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SP CERV INTERBODY DEV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4970.7, "maximum": 4970.7, "gross_charge": 23670.0, "discounted_cash": 17752.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4970.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP CERV STANDLNE INT DEV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2574.81, "maximum": 2574.81, "gross_charge": 12261.0, "discounted_cash": 9195.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2574.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP CERV STNLN INT DV SCR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 149.73, "maximum": 149.73, "gross_charge": 713.0, "discounted_cash": 534.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 149.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP CLAMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 749.7, "maximum": 749.7, "gross_charge": 3570.0, "discounted_cash": 2677.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 749.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP CLAMP CONNECTOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 479.01, "maximum": 479.01, "gross_charge": 2281.0, "discounted_cash": 1710.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 479.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP COG FUNC ACTIVITY ADDL 15M", "code_information": [{"code": "97130", "type": "CPT"}, {"code": "5907130", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP COG FUNC ACTIVITY ADDL 15M", "code_information": [{"code": "97130", "type": "CPT"}, {"code": "6057136", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP COG FUNC ACTIVITY INIT 15M", "code_information": [{"code": "97129", "type": "CPT"}, {"code": "5907129", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP COG FUNC ACTIVITY INIT 15M", "code_information": [{"code": "97129", "type": "CPT"}, {"code": "6057134", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP CROSSLINK ASSEMBLY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 479.01, "maximum": 479.01, "gross_charge": 2281.0, "discounted_cash": 1710.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 479.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP EVAL BEH QUAL A V/RS BASIC", "code_information": [{"code": "92524", "type": "CPT"}, {"code": "5902524", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 643.0, "discounted_cash": 482.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL BEH QUAL A V/RS BASIC", "code_information": [{"code": "92524", "type": "CPT"}, {"code": "6052813", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1007.0, "discounted_cash": 755.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL BEH QUAL A V/RS CMPLX", "code_information": [{"code": "92524", "type": "CPT"}, {"code": "5900531", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1928.0, "discounted_cash": 1446.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL BEH QUAL A V/RS CMPLX", "code_information": [{"code": "92524", "type": "CPT"}, {"code": "6050821", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1255.0, "discounted_cash": 941.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL BEH QUAL A V/RS EXTNSV", "code_information": [{"code": "92524", "type": "CPT"}, {"code": "5900532", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 2571.0, "discounted_cash": 1928.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL BEH QUAL A V/RS EXTNSV", "code_information": [{"code": "92524", "type": "CPT"}, {"code": "6050822", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 774.0, "discounted_cash": 580.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL BEH QUAL A V/RS INTERM", "code_information": [{"code": "92524", "type": "CPT"}, {"code": "6050820", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1546.0, "discounted_cash": 1159.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL BEH QUAL A W/RS INTERM", "code_information": [{"code": "92524", "type": "CPT"}, {"code": "5900530", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1284.0, "discounted_cash": 963.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL CINE VIDEO", "code_information": [{"code": "92611", "type": "CPT"}, {"code": "5902611", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1163.0, "discounted_cash": 872.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL CINE VIDEO BASIC", "code_information": [{"code": "92611", "type": "CPT"}, {"code": "6052611", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 788.0, "discounted_cash": 591.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL CINE VIDEO CMPLX", "code_information": [{"code": "92611", "type": "CPT"}, {"code": "5902635", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 3484.0, "discounted_cash": 2613.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL CINE VIDEO COMPLEX", "code_information": [{"code": "92611", "type": "CPT"}, {"code": "6050829", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1003.0, "discounted_cash": 752.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL CINE VIDEO EXTENSIVE", "code_information": [{"code": "92611", "type": "CPT"}, {"code": "6052605", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 1320.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL CINE VIDEO EXTNSV", "code_information": [{"code": "92611", "type": "CPT"}, {"code": "5902637", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 4647.0, "discounted_cash": 3485.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL CINE VIDEO INTERM", "code_information": [{"code": "92611", "type": "CPT"}, {"code": "5902633", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 2323.0, "discounted_cash": 1742.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL CINE VIDEO INTERMEDATE", "code_information": [{"code": "92611", "type": "CPT"}, {"code": "6050828", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 668.0, "discounted_cash": 501.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL FLUENCY BASIC", "code_information": [{"code": "92521", "type": "CPT"}, {"code": "5902521", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 643.0, "discounted_cash": 482.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL FLUENCY BASIC", "code_information": [{"code": "92521", "type": "CPT"}, {"code": "6052810", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1755.0, "discounted_cash": 1316.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL FLUENCY COMPLEX", "code_information": [{"code": "92521", "type": "CPT"}, {"code": "5900522", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1928.0, "discounted_cash": 1446.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL FLUENCY COMPLEX", "code_information": [{"code": "92521", "type": "CPT"}, {"code": "6050812", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1755.0, "discounted_cash": 1316.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL FLUENCY EXTENSIVE", "code_information": [{"code": "92521", "type": "CPT"}, {"code": "5900523", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 2571.0, "discounted_cash": 1928.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL FLUENCY EXTENSIVE", "code_information": [{"code": "92521", "type": "CPT"}, {"code": "6050813", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 2340.0, "discounted_cash": 1755.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL FLUENCY INTERM", "code_information": [{"code": "92521", "type": "CPT"}, {"code": "5900521", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1284.0, "discounted_cash": 963.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL FLUENCY INTERM", "code_information": [{"code": "92521", "type": "CPT"}, {"code": "6050811", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1171.0, "discounted_cash": 878.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL FLUENCY-TELEMED", "code_information": [{"code": "92521", "type": "CPT"}, {"code": "5902517", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 439.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GN|95"}, {"description": "SP EVAL FLUENCY-TELEMED", "code_information": [{"code": "92521", "type": "CPT"}, {"code": "6052516", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 439.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GN|95"}, {"description": "SP EVAL LNG COM W/EXP BASIC", "code_information": [{"code": "92523", "type": "CPT"}, {"code": "5902523", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 426.0, "discounted_cash": 319.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL LNG COM W/EXP BASIC", "code_information": [{"code": "92523", "type": "CPT"}, {"code": "6052812", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 2027.0, "discounted_cash": 1520.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL LNG COM W/EXP COMPLEX", "code_information": [{"code": "92523", "type": "CPT"}, {"code": "5900528", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1283.0, "discounted_cash": 962.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL LNG COM W/EXP COMPLEX", "code_information": [{"code": "92523", "type": "CPT"}, {"code": "6050818", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 2194.0, "discounted_cash": 1645.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL LNG COM W/EXP EXTENSVE", "code_information": [{"code": "92523", "type": "CPT"}, {"code": "5900529", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 1710.0, "discounted_cash": 1282.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL LNG COM W/EXP EXTNSV", "code_information": [{"code": "92523", "type": "CPT"}, {"code": "6050819", "type": "CDM"}, {"code": "444", "type": "RC"}], 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1574.0, "discounted_cash": 1180.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 185.35, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 82.44, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 82.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 82.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 82.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 82.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEC TELETHER PORT PLAN", "code_information": [{"code": "77321", "type": "CPT"}, {"code": "5107321", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 557.55, "gross_charge": 1727.0, "discounted_cash": 1295.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 362.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 444.07, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 175.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 501.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 175.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 175.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 175.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 175.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL CASTING MATERIAL", "code_information": [{"code": "A4590", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL DOSIMETRY", "code_information": [{"code": "77331", "type": "CPT"}, {"code": "5107331", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 214.43, "gross_charge": 528.0, "discounted_cash": 396.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 110.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 67.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 193.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 67.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 67.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 67.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 67.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99190", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99191", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99192", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL STAIN SMEAR/2", "code_information": [{"code": "87207", "type": "CPT"}, {"code": "4107202", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.55, "gross_charge": 166.0, "discounted_cash": 124.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL STAIN SMEAR/3", "code_information": [{"code": "87207", "type": "CPT"}, {"code": "7258720", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.55, "gross_charge": 180.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIMEN HANDLING", "code_information": [{"code": "99001", "type": "CPT"}, {"code": "4301922", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 6.63, "maximum": 124.0, "gross_charge": 124.0, "discounted_cash": 93.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIMEN HANDLING", "code_information": [{"code": "99001", "type": "CPT"}, {"code": "7270156", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 6.63, "maximum": 145.0, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 145.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIMEN HANDLING OFFICE-LAB", "code_information": [{"code": "99000", "type": "CPT"}], "standard_charges": [{"minimum": 5.58, "maximum": 5.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIMEN SITE NOT ESOPHAGUS", "code_information": [{"code": "G8797", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIMEN SITE NOT PROSTATE", "code_information": [{"code": "G8798", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECTINOMYCN DI-HCL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3320", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.07, "maximum": 30.08, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 30.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 30.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 30.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECTROPHOTOMETRY NES/8", "code_information": [{"code": "84311", "type": "CPT"}, {"code": "7258453", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.66, "gross_charge": 136.0, "discounted_cash": 102.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 35.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH AUDIOMETRY COMPLETE", "code_information": [{"code": "92556", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH EVALUATION COMPLEX", "code_information": [{"code": "70371", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 249.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 249.64, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH SOUND LANG COMPREHEN", "code_information": [{"code": "92523", "type": "CPT"}], "standard_charges": [{"minimum": 394.36, "maximum": 450.99, "estimated_discounted_cash": 840.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 405.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 394.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 450.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 450.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 450.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH THERAPY, IN THE HOME,", "code_information": [{"code": "S9128", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEECH THERAPY, RE-EVAL", "code_information": [{"code": "S9152", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPEECH THRESHOLD AUDIOMETRY", "code_information": [{"code": "92555", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH/HEARING THERAPY", "code_information": [{"code": "92507", "type": "CPT"}], "standard_charges": [{"minimum": 56.92, "maximum": 180.48, "estimated_discounted_cash": 832.95, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 56.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 162.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 157.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 180.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 180.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 180.48, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 56.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 56.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 56.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 56.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH/HEARING THERAPY", "code_information": [{"code": "92508", "type": "CPT"}], "standard_charges": [{"minimum": 26.46, "maximum": 54.93, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 48.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 54.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 54.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 54.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH/LANG TX BASIC", "code_information": [{"code": "92507", "type": "CPT"}, {"code": "5901007", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 216.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX BASIC", "code_information": [{"code": "92507", "type": "CPT"}, {"code": "6052520", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 497.0, "discounted_cash": 372.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX CMPLX", "code_information": [{"code": "92507", "type": "CPT"}, {"code": "5901009", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 862.0, "discounted_cash": 646.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX COMPLEX", "code_information": [{"code": "92507", "type": "CPT"}, {"code": "6052522", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 439.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX EXTENSIVE", "code_information": [{"code": "92507", "type": "CPT"}, {"code": "6052523", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 1324.0, "discounted_cash": 993.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX EXTNSV", "code_information": [{"code": "92507", "type": "CPT"}, {"code": "5901005", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 1151.0, "discounted_cash": 863.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX GRP BASIC", "code_information": [{"code": "92508", "type": "CPT"}, {"code": "5901013", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX GRP COMPLEX", "code_information": [{"code": "92508", "type": "CPT"}, {"code": "5901015", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 222.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX GRP EXTNSV", "code_information": [{"code": "92508", "type": "CPT"}, {"code": "5901016", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 297.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX GRP INTER", "code_information": [{"code": "92508", "type": "CPT"}, {"code": "5901014", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 197.0, "discounted_cash": 147.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX INTER", "code_information": [{"code": "92507", "type": "CPT"}, {"code": "5901008", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 429.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX INTERMEDIATE", "code_information": [{"code": "92507", "type": "CPT"}, {"code": "6052521", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 541.0, "discounted_cash": 405.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPERM ANTIBODIES", "code_information": [{"code": "89325", "type": "CPT"}, {"code": "7259325", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.42, "gross_charge": 459.0, "discounted_cash": 344.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM EVALUATION TEST", "code_information": [{"code": "89329", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 106.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 106.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.3, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM IDENTIFICATION", "code_information": [{"code": "89257", "type": "CPT"}], "standard_charges": [{"minimum": 49.76, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION COMPLEX", "code_information": [{"code": "89261", "type": "CPT"}], "standard_charges": [{"minimum": 49.76, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION SIMPLE", "code_information": [{"code": "89260", "type": "CPT"}], "standard_charges": [{"minimum": 49.76, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM PROCURE INIT VISIT", "code_information": [{"code": "S4030", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPERM PROCURE SUBS VISIT", "code_information": [{"code": "S4031", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPERM WASHING", "code_information": [{"code": "58323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPHENOID SINUS SURGERY", "code_information": [{"code": "31051", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPHINCTERTOME DREAMTOME RX", 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"PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 73.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 73.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPIN/BRAIN PUMP REFIL & MAIN", "code_information": [{"code": "95991", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 99.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 346.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 337.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 385.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 385.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 385.46, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 99.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 99.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 99.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 99.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL CAGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6026.79, "maximum": 6026.79, "gross_charge": 28699.0, "discounted_cash": 21524.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6026.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL CAGE INFUSE SPNL ELMNTS", "code_information": [{"code": "C1821", "type": "HCPCS"}, {"code": "8137897", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6477.03, "maximum": 6477.03, "gross_charge": 30843.0, "discounted_cash": 23132.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6477.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL DISK SURGERY ADD-ON", "code_information": [{"code": "63035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 195.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 195.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 195.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 195.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 195.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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35934.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11941.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18374.29, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10171.79, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6633.78, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4384.69, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 26738.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 60138.78, "methodology": "case rate"}, 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10115.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 38245.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 38245.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10115.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12900.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16808.75, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12900.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS 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{"description": "SPINE CERV 6 > VWS", "code_information": [{"code": "72052", "type": "CPT"}, {"code": "5012052", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 386.4, "gross_charge": 1840.0, "discounted_cash": 1380.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 386.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 151.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 75.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 75.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 75.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 75.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 75.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE CERVICAL 2 VIEWS", "code_information": [{"code": "72040", "type": "CPT"}, {"code": "4902040", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 231.63, "gross_charge": 1103.0, "discounted_cash": 827.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 231.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.78, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE CERVICAL 2 VIEWS", "code_information": [{"code": "72040", "type": "CPT"}, {"code": "5012040", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 231.63, "gross_charge": 1103.0, "discounted_cash": 827.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 231.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO 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"standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE CERVICAL 3 VIEWS", "code_information": [{"code": "72040", "type": "CPT"}, {"code": "4902042", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 231.63, "gross_charge": 1103.0, "discounted_cash": 827.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 231.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE CERVICAL 3 VIEWS", "code_information": [{"code": "72040", "type": "CPT"}, {"code": "5012042", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 167.58, "gross_charge": 798.0, "discounted_cash": 598.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 167.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.78, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE CERVICAL 4 OR 5 VW", "code_information": [{"code": "72050", "type": "CPT"}, {"code": "4902050", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 633.57, "gross_charge": 3017.0, "discounted_cash": 2262.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 633.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 120.42, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE CERVICAL 4 OR 5 VW", "code_information": [{"code": "72050", "type": "CPT"}, {"code": "5012050", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 633.57, "gross_charge": 3017.0, "discounted_cash": 2262.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 633.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 120.42, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE DEVICE IMPLANT SURGERY", "code_information": [{"code": "C9757", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 49462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44515.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49462.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINE DISK SURGERY THORAX", "code_information": [{"code": "63077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1445.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1445.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1445.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1445.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1445.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINE DISK SURGERY THORAX", "code_information": [{"code": "63078", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 197.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 197.59, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 197.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 197.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 197.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINE LUMBAR 2 VIEWS", "code_information": [{"code": "72100", "type": "CPT"}, {"code": "4902100", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 249.48, "gross_charge": 1188.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 249.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 90.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE LUMBAR 2 VIEWS", "code_information": [{"code": "72100", "type": "CPT"}, {"code": "5012100", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 249.48, "gross_charge": 1188.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 249.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 90.33, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE LUMBAR 3 VIEWS", "code_information": [{"code": "72100", "type": "CPT"}, {"code": "4902101", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 249.48, "gross_charge": 1188.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 249.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 90.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE LUMBAR 3 VIEWS", "code_information": [{"code": "72100", "type": "CPT"}, {"code": "5012101", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 108.97, "gross_charge": 136.0, "discounted_cash": 102.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 28.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 90.33, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 44.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE LUMBAR MIN 4VWS", "code_information": [{"code": "72110", "type": "CPT"}, {"code": "4902110", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 405.3, "gross_charge": 1930.0, "discounted_cash": 1447.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 405.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 124.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 195.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 195.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 195.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 195.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 195.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH CC", "code_information": [{"code": "800", "type": "MS-DRG"}], "standard_charges": [{"minimum": 93277.7, "maximum": 117542.49, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 93277.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 117542.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH MCC", "code_information": [{"code": "799", "type": "MS-DRG"}], "standard_charges": [{"minimum": 150368.54, "maximum": 189484.65, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 150368.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 189484.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "801", "type": "MS-DRG"}], "standard_charges": [{"minimum": 63379.3, "maximum": 79866.47, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63379.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 79866.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLENOPORTOGRAPHY", "code_information": [{"code": "75810", "type": "CPT"}, {"code": "4915811", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 4959.78, "gross_charge": 23618.0, "discounted_cash": 17713.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4959.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLICE SPLEEN/KIDNEY VEINS", "code_information": [{"code": "37181", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1523.7, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1523.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1523.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1523.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1523.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLICING OF URETERS", "code_information": [{"code": "50770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1196.9, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1196.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1196.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1196.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1196.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLINT", "code_information": [{"code": "A4570", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.3, "maximum": 25.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 22.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLINT DIGIT", "code_information": [{"code": "S8450", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLINT ELBOW", "code_information": [{"code": "S8452", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLINT SUPPLIES MISC", "code_information": [{"code": "Q4051", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLINT WRIST OR ANKLE", "code_information": [{"code": "S8451", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLITTING BLD PROD EA UT", "code_information": [{"code": "86985", "type": "CPT"}, {"code": "4106967", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "gross_charge": 233.0, "discounted_cash": 174.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLITTING BLD PROD EA UT", "code_information": [{"code": "86985", "type": "CPT"}, {"code": "4126985", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "gross_charge": 233.0, "discounted_cash": 174.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPONTANEOUS NYSTAGMUS TEST", "code_information": [{"code": "92541", "type": "CPT"}], "standard_charges": [{"minimum": 65.03, "maximum": 165.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 65.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 149.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 145.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 165.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 65.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 65.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 65.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 65.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC", "code_information": [{"code": "537", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31684.67, "maximum": 39926.96, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31684.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39926.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC", "code_information": [{"code": "538", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23915.4, "maximum": 30136.63, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23915.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30136.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPRCHOROIDAL SPC NJX RX AGT", "code_information": [{"code": "67516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPUTUM INDUCTION", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "5500223", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 16.25, "maximum": 298.43, "gross_charge": 615.0, "discounted_cash": 461.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 268.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 260.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 298.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPUTUM SPCMN", "code_information": [{"code": "89220", "type": "CPT"}, {"code": "5509220", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 149.16, "gross_charge": 475.0, "discounted_cash": 356.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 59.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SR89 STRONTIUM", "code_information": [{"code": "A9600", "type": "HCPCS"}], "standard_charges": [{"minimum": 2976.74, "maximum": 3306.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2976.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3306.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3306.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3306.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3306.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRCH FOR CT W IN 12 MOS", "code_information": [{"code": "G9341", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SRS CRAN LES COMPLEX ADDL", "code_information": [{"code": "61799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57137.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS CRAN LES SIMPLE ADDL", "code_information": [{"code": "61797", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57137.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION COMPLEX", "code_information": [{"code": "61798", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57137.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION SIMPLE", "code_information": [{"code": "61796", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57137.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS MULTISOURCE", "code_information": [{"code": "77371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57137.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1389.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11923.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13243.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13243.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13243.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13243.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1389.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1389.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1389.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1389.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION", "code_information": [{"code": "63620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57137.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION ADDL", "code_information": [{"code": "63621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57137.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed 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{"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1967.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1967.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS TX CRANL LIN ACCL", "code_information": [{"code": "77372", "type": "CPT"}, {"code": "5107374", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 57137.0, "gross_charge": 34379.0, "discounted_cash": 25784.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 7219.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3832.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1054.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11923.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13243.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13243.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF 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"standard_charge_dollar": 1054.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRSF2 GENE COMMON VARIANTS", "code_information": [{"code": "81348", "type": "CPT"}], "standard_charges": [{"minimum": 175.4, "maximum": 175.4, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST ACCESS LIVER TRNSJUG", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8034187", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 610.05, "maximum": 610.05, "gross_charge": 2905.0, "discounted_cash": 2178.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 610.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST ANCH GASTROINT W/FSTN", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8086983", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 207.48, "maximum": 207.48, "gross_charge": 988.0, "discounted_cash": 741.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 207.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST CATH EVD BACTISEAL", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8082681", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 740.46, "maximum": 740.46, "gross_charge": 3526.0, "discounted_cash": 2644.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 740.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST COLON DECOMPRESS W GW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8082686", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 240.66, "maximum": 240.66, "gross_charge": 1146.0, "discounted_cash": 859.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 240.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST CYLINDR/PUMP SCROTAL", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "8156021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 14697.06, "maximum": 14697.06, "gross_charge": 69986.0, "discounted_cash": 52489.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 14697.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST DIL RENAL AMPLATZ", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "8243050", "type": "CDM"}], "standard_charges": [{"minimum": 1279.74, "maximum": 1279.74, "gross_charge": 6094.0, "discounted_cash": 4570.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1279.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST INTRO PEEL-AWAY", "code_information": [{"code": "C1892", "type": "HCPCS"}, {"code": "8248550", "type": "CDM"}], "standard_charges": [{"minimum": 72.87, "maximum": 72.87, "gross_charge": 347.0, "discounted_cash": 260.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 72.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST INTRO PEELAWAY W GW", "code_information": [{"code": "C1892", "type": "HCPCS"}, {"code": "8248551", "type": "CDM"}], "standard_charges": [{"minimum": 53.13, "maximum": 53.13, "gross_charge": 253.0, "discounted_cash": 189.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 53.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST INTROD PERFORMER W/GW", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8185303", "type": "CDM"}], "standard_charges": [{"minimum": 40.95, "maximum": 40.95, "gross_charge": 195.0, "discounted_cash": 146.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 40.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST PERC INTRO VLV & DIL", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8177251", "type": "CDM"}], "standard_charges": [{"minimum": 243.81, "maximum": 243.81, "gross_charge": 1161.0, "discounted_cash": 870.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 243.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST PERCUTANEOUS INTROD", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8034169", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 39.9, "maximum": 39.9, "gross_charge": 190.0, "discounted_cash": 142.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 39.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST THROMB ZELANTE DVT", "code_information": [{"code": "C1757", "type": "HCPCS"}, {"code": "8058500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4293.03, "maximum": 4293.03, "gross_charge": 20443.0, "discounted_cash": 15332.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 4293.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST THROMBECT SOLENT OMNI", "code_information": [{"code": "C1757", "type": "HCPCS"}, {"code": "8084942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1856.4, "maximum": 1856.4, "gross_charge": 8840.0, "discounted_cash": 6630.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1856.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST VENA CAVA FLTR RETRVL", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "8177274", "type": "CDM"}], "standard_charges": [{"minimum": 814.8, "maximum": 814.8, "gross_charge": 3880.0, "discounted_cash": 2910.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 814.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAB PHLEB VEINS XTR 10-20", "code_information": [{"code": "37765", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STAGGERED SPONDAIC WORD TEST", "code_information": [{"code": "92572", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STANDING FRAME SYS", "code_information": [{"code": "E0638", "type": "HCPCS"}], "standard_charges": [{"minimum": 1761.41, "maximum": 2014.3, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1813.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1761.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2014.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2014.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2014.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPH A DNA AMP PROBE", "code_information": [{"code": "87640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE BN NITINOL DYN W INST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2269.26, "maximum": 2269.26, "gross_charge": 10806.0, "discounted_cash": 8104.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2269.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1933.26, "maximum": 1933.26, "gross_charge": 9206.0, "discounted_cash": 6904.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1933.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAT LAB", "code_information": [{"code": "S3600", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAT LAB HOME/NF", "code_information": [{"code": "S3601", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STATIN MED PRES AT DISCH", "code_information": [{"code": "G8816", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STEM CELLS TOTAL COUNT", "code_information": [{"code": "86367", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 192.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 192.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 77.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 77.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FEM CT HA ANT ACT DPY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2485.35, "maximum": 2485.35, "gross_charge": 11835.0, "discounted_cash": 8876.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2485.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FEM CT HA PA SCR STRY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2786.91, "maximum": 2786.91, "gross_charge": 13271.0, "discounted_cash": 9953.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2786.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMRL COATD TORNIER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3233.37, "maximum": 3233.37, "gross_charge": 15397.0, "discounted_cash": 11547.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3233.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM KNEE CEMENTED STRYKR CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 598.71, "maximum": 598.71, "gross_charge": 2851.0, "discounted_cash": 2138.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 598.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM KNEE DEPU", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8136585", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1609.65, "maximum": 1609.65, "gross_charge": 7665.0, "discounted_cash": 5748.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1609.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM SPACER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8136595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1556.94, "maximum": 1556.94, "gross_charge": 7414.0, "discounted_cash": 5560.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1556.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM STANDARD INHANCE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8131244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3171.0, "maximum": 3171.0, "gross_charge": 15100.0, "discounted_cash": 11325.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3171.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENGER TEST PURE TONE", "code_information": [{"code": "92565", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENGER TEST SPEECH", "code_information": [{"code": "92577", "type": "CPT"}], "standard_charges": [{"minimum": 620.07, "maximum": 709.1, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PLACEMT ANTE CAROTID", "code_information": [{"code": "37218", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STENT PLACEMT RETRO CAROTID", "code_information": [{"code": "37217", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STENT PLMT CTR DIALYSIS SEG", "code_information": [{"code": "36908", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STENT, COATED/COV W/O DEL SY", "code_information": [{"code": "C1875", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STEREOISOMER ANALYSIS", "code_information": [{"code": "80374", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOSCOPIC X-RAY GUIDANCE", "code_information": [{"code": "G6002", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 151.64, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 136.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 151.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 151.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 151.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 151.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOTACTIC RADIATION TRMT", "code_information": [{"code": "77432", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57137.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1302.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 409.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 964.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1071.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1071.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1071.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1071.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 409.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 409.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 409.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 409.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STERILE NEEDLE", "code_information": [{"code": "A4215", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STERILE SALINE OR WATER", "code_information": [{"code": "A4218", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STERILE, GLOVES PER PAIR", "code_information": [{"code": "A4930", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STERNAL DEBRIDEMENT", "code_information": [{"code": "21627", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 548.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 548.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 548.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 548.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 548.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STERNCLAVR JNTS 3VW MIN", "code_information": [{"code": "71130", "type": "CPT"}, {"code": "4901130", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 219.45, "gross_charge": 1045.0, "discounted_cash": 783.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 219.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.81, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STERNCLAVR JNTS 3VW MIN", "code_information": [{"code": "71130", "type": "CPT"}, {"code": "5011130", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 219.45, "gross_charge": 1045.0, "discounted_cash": 783.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 219.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STERNUM 2VW MIN", "code_information": [{"code": "71120", "type": "CPT"}, {"code": "4901120", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 238.77, "gross_charge": 1137.0, "discounted_cash": 852.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 238.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STERNUM 2VW MIN", "code_information": [{"code": "71120", "type": "CPT"}, {"code": "5011120", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 238.77, "gross_charge": 1137.0, "discounted_cash": 852.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 238.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULANTS SYNTHETIC", "code_information": [{"code": "80371", "type": "CPT"}, {"code": "7250382", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 1397.0, "discounted_cash": 1047.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATED IUI CASE RATE", "code_information": [{"code": "S4035", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATION OF SPINAL CORD", "code_information": [{"code": "63610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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schedule"}], "billing_class": "facility"}]}, {"description": "STNT B BLN PALMAZ EXPAND", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8243132", "type": "CDM"}], "standard_charges": [{"minimum": 1581.09, "maximum": 1581.09, "gross_charge": 7529.0, "discounted_cash": 5646.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1581.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B COTTN LEUNG WO DL", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "4024795", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.33, "maximum": 78.33, "gross_charge": 373.0, "discounted_cash": 279.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 78.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B EXPRESS LD", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8243136", "type": "CDM"}], "standard_charges": [{"minimum": 1253.49, "maximum": 1253.49, "gross_charge": 5969.0, "discounted_cash": 4476.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1253.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B FLEXSTAR", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "4024797", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2602.74, "maximum": 2602.74, "gross_charge": 12394.0, "discounted_cash": 9295.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2602.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B LUMINEX", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8243138", "type": "CDM"}], "standard_charges": [{"minimum": 903.63, "maximum": 903.63, "gross_charge": 4303.0, "discounted_cash": 3227.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 903.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B PALMAZ GENESIS", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8243162", "type": "CDM"}], "standard_charges": [{"minimum": 1357.23, "maximum": 1357.23, "gross_charge": 6463.0, "discounted_cash": 4847.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1357.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B PALMAZ XL", "code_information": [{"code": "C1877", "type": "HCPCS"}, {"code": "8248618", "type": "CDM"}], "standard_charges": [{"minimum": 1581.09, "maximum": 1581.09, "gross_charge": 7529.0, "discounted_cash": 5646.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1581.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B PALMZ BLU TRNSHPT", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1295.28, "maximum": 1295.28, "gross_charge": 6168.0, "discounted_cash": 4626.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1295.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B PROTEGE EVERFLEX", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "4024808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3357.27, "maximum": 3357.27, "gross_charge": 15987.0, "discounted_cash": 11990.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3357.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B PROTEGE GPS", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "4028735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1295.28, "maximum": 1295.28, "gross_charge": 6168.0, "discounted_cash": 4626.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1295.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B RENAL EXPRESS SD", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "4024815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1359.54, "maximum": 1359.54, "gross_charge": 6474.0, "discounted_cash": 4855.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1359.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B SLF-EXP SENTINOL", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "4024809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 979.23, "maximum": 979.23, "gross_charge": 4663.0, "discounted_cash": 3497.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 979.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B ST2 SOEHNDRA TANN", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "4024814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 95.76, "maximum": 95.76, "gross_charge": 456.0, "discounted_cash": 342.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 95.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B TH SMART NITINOL2", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8243117", "type": "CDM"}], "standard_charges": [{"minimum": 1500.66, "maximum": 1500.66, "gross_charge": 7146.0, "discounted_cash": 5359.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1500.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B VALEO BLN EXPND", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 979.23, "maximum": 979.23, "gross_charge": 4663.0, "discounted_cash": 3497.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 979.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B VAS E-LIMINEXX", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "4024816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 903.63, "maximum": 903.63, "gross_charge": 4303.0, "discounted_cash": 3227.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 903.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B VISIPRO", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "4024817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1010.73, "maximum": 1010.73, "gross_charge": 4813.0, "discounted_cash": 3609.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1010.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B WALLFLEX RX CVR", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "8062056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B WALLFLX RX UNCVR", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "4024818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2485.35, "maximum": 2485.35, "gross_charge": 11835.0, "discounted_cash": 8876.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2485.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B XPERT OTW", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8243163", "type": "CDM"}], "standard_charges": [{"minimum": 1343.58, "maximum": 1343.58, "gross_charge": 6398.0, "discounted_cash": 4798.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1343.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT B ZILVER", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8243166", "type": "CDM"}], "standard_charges": [{"minimum": 3499.23, "maximum": 3499.23, "gross_charge": 16663.0, "discounted_cash": 12497.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3499.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT BILIARY RACER OTW", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 171.78, "maximum": 171.78, "gross_charge": 818.0, "discounted_cash": 613.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 171.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT C ACS MULTILNK ULT", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8243184", "type": "CDM"}], "standard_charges": [{"minimum": 488.67, "maximum": 488.67, "gross_charge": 2327.0, "discounted_cash": 1745.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 488.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT C GR II", "code_information": [{"code": "C1877", "type": "HCPCS"}, {"code": "8243186", "type": "CDM"}], "standard_charges": [{"minimum": 3609.06, "maximum": 3609.06, "gross_charge": 17186.0, "discounted_cash": 12889.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3609.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT C GRAFTMASTER RX", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "8062082", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT C INTEGRITY BMS RX", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062067", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 598.71, "maximum": 598.71, "gross_charge": 2851.0, "discounted_cash": 2138.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 598.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT C PACLITAXEL", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4025005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT C PROMUS RX", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4025001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, 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"type": "HCPCS"}, {"code": "8062146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 101.22, "maximum": 101.22, "gross_charge": 482.0, "discounted_cash": 361.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 101.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT URETERAL", "code_information": [{"code": "C2625", "type": "HCPCS"}, {"code": "8062145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 715.47, "maximum": 715.47, "gross_charge": 3407.0, "discounted_cash": 2555.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 715.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT URETERAL", "code_information": [{"code": "C2625", "type": "HCPCS"}, {"code": "8062150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 147.63, "maximum": 147.63, "gross_charge": 703.0, "discounted_cash": 527.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 147.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT VAS ZILVER 635 SE", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 964.11, "maximum": 964.11, "gross_charge": 4591.0, "discounted_cash": 3443.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 964.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT VASC BIL LIFESTAR", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 715.47, "maximum": 715.47, "gross_charge": 3407.0, "discounted_cash": 2555.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 715.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT VASC COVERED LIFESTREAM", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "8062194", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT VASC EPIC SLF EXPND", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1581.72, "maximum": 1581.72, "gross_charge": 7532.0, "discounted_cash": 5649.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1581.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT VASC LIFESTENT", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1129.8, "maximum": 1129.8, "gross_charge": 5380.0, "discounted_cash": 4035.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1129.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT VASC RECONSTR DLV", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STNT VENOUS VICI", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8067803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2259.39, "maximum": 2259.39, "gross_charge": 10759.0, "discounted_cash": 8069.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2259.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [{"code": "327", "type": "MS-DRG"}], "standard_charges": [{"minimum": 81152.33, "maximum": 102262.88, "estimated_discounted_cash": 134061.5, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 81152.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 102262.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC", "code_information": [{"code": "326", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17330.01, "maximum": 208667.83, "estimated_discounted_cash": 151437.13, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 29713.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 27989.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 55374.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42255.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31265.35, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 44462.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 29451.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 58267.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 61528.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 46951.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33015.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 31099.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33015.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 31099.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 61528.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 46951.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 31099.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 61528.13, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 46951.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33015.2, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 32221.77, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 18515.88, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 17330.01, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 28604.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 165591.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 208667.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "328", "type": "MS-DRG"}], "standard_charges": [{"minimum": 53199.56, "maximum": 67038.63, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 53199.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 67038.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR EMBRYO(S)", "code_information": [{"code": "89342", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR OOCYTE(S)", "code_information": [{"code": "89346", "type": "CPT"}], "standard_charges": [{"minimum": 291.26, "maximum": 291.26, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR REPROD TISSUE", "code_information": [{"code": "89344", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR SPERM/SEMEN", "code_information": [{"code": "89343", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STORE PREV FROZ EMBRYOS", "code_information": [{"code": "S4027", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STPL FIXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1427.16, "maximum": 1427.16, "gross_charge": 6796.0, "discounted_cash": 5097.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1427.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STPL LINE REINFORCEMENT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "8185138", "type": "CDM"}], "standard_charges": [{"minimum": 453.39, "maximum": 453.39, "gross_charge": 2159.0, "discounted_cash": 1619.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 453.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STR MARKERS SPEC ANAL ADDL", "code_information": [{"code": "81266", "type": "CPT"}], "standard_charges": [{"minimum": 304.81, "maximum": 304.81, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 304.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 304.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STR MARKERS SPECIMEN ANAL", "code_information": [{"code": "81265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1098.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1098.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 233.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 233.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF ANKLE AND/OR FT", "code_information": [{"code": "29540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3814.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF CHEST", "code_information": [{"code": "29200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF ELBOW OR WRIST", "code_information": [{"code": "29260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF HAND OR FINGER", "code_information": [{"code": "29280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF HIP", "code_information": [{"code": "29520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF KNEE", "code_information": [{"code": "29530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF PASTE BOOT", "code_information": [{"code": "6900092", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 884.0, "discounted_cash": 663.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAPPING OF PASTE BOOT", "code_information": [{"code": "6900092", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 884.0, "discounted_cash": 663.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAPPING OF SHOULDER", "code_information": [{"code": "29240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF TOES", "code_information": [{"code": "29550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRATTICE TM PER SQ CM SKINSUB", "code_information": [{"code": "Q4130", "type": "HCPCS"}, {"code": "4028740", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 104.79, "maximum": 104.79, "gross_charge": 499.0, "discounted_cash": 374.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 104.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRATTICE TM PER SQ CM SKINSUB", "code_information": [{"code": "Q4130", "type": "HCPCS"}, {"code": "4028740", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 104.79, "maximum": 104.79, "gross_charge": 499.0, "discounted_cash": 374.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 104.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAVIX 2CM X 2CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4028745", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1506.12, "maximum": 1506.12, "gross_charge": 7172.0, "discounted_cash": 5379.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1506.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAVIX 2CM X 2CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4028745", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1506.12, "maximum": 1506.12, "gross_charge": 7172.0, "discounted_cash": 5379.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1506.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAVIX 2CMX4CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4028746", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 317.1, "gross_charge": 1510.0, "discounted_cash": 1132.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAVIX 2CMX4CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4028746", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 317.1, "gross_charge": 1510.0, "discounted_cash": 1132.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAVIX 3CMX6CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4028747", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 223.65, "maximum": 223.65, "gross_charge": 1065.0, "discounted_cash": 798.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 223.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAVIX 3CMX6CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4028747", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 223.65, "maximum": 223.65, "gross_charge": 1065.0, "discounted_cash": 798.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 223.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAVIX PL 2CMX4CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4028748", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 249.48, "maximum": 249.48, "gross_charge": 1188.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 249.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAVIX PL 2CMX4CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4028748", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 249.48, "maximum": 249.48, "gross_charge": 1188.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 249.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAVIX PL 3CMX6CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4028749", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 179.13, "maximum": 179.13, "gross_charge": 853.0, "discounted_cash": 639.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 179.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAVIX PL 3CMX6CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4028749", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 179.13, "maximum": 179.13, "gross_charge": 853.0, "discounted_cash": 639.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 179.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A AMP PROBE", "code_information": [{"code": "87651", "type": "CPT"}, {"code": "4107651", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "gross_charge": 185.0, "discounted_cash": 138.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A DNA DIR PROBE", "code_information": [{"code": "87650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 102.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 102.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A DNA QUANT", "code_information": [{"code": "87652", "type": "CPT"}], 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"standard_charge_dollar": 58.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP B ASSAY W/OPTIC", "code_information": [{"code": "87802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP B DNA AMP PROBE", "code_information": [{"code": "87653", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee 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DIR OPT", "code_information": [{"code": "87880", "type": "CPT"}, {"code": "4106410", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 519.0, "discounted_cash": 389.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREPTOCOCCUS A DIR OPT", "code_information": [{"code": "87880", "type": "CPT"}, {"code": "6709922", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 519.0, "discounted_cash": 389.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREPTOCOCCUS A IA/2", "code_information": [{"code": "87430", "type": "CPT"}, {"code": "4106411", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 486.0, "discounted_cash": 364.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREPTOKINASE ANTIBODY", "code_information": [{"code": "86590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 56.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 56.25, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRESS MGMT CLASS", "code_information": [{"code": "S9454", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRESS TTE COMPLETE", "code_information": [{"code": "93351", "type": "CPT"}], "standard_charges": [{"minimum": 677.57, "maximum": 774.86, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 697.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 677.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRESS VWS ANY", "code_information": [{"code": "77071", "type": "CPT"}, {"code": "4906008", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 231.63, "gross_charge": 1103.0, "discounted_cash": 827.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 231.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 95.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRESS VWS ANY", "code_information": [{"code": "77071", "type": "CPT"}, {"code": "5016006", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 231.63, "gross_charge": 1103.0, "discounted_cash": 827.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 231.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 95.33, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRIATED AB SCR", "code_information": [{"code": "86255", "type": "CPT"}, {"code": "7251260", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.47, "gross_charge": 59.0, "discounted_cash": 44.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.47, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRK CR PREV POS OUTCME MVP", "code_information": [{"code": "G0054", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STRP PERI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8034258", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 263.97, "maximum": 263.97, "gross_charge": 1257.0, "discounted_cash": 942.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 263.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBQ INF EACH ADD HOUR", "code_information": [{"code": "96370", "type": "CPT"}, {"code": "3106370", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 51.59, "maximum": 59.0, "gross_charge": 118.0, "discounted_cash": 88.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 53.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 51.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBQ INF THER/PROPH 1HR", "code_information": [{"code": "96369", "type": "CPT"}, {"code": "3106369", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 254.93, "maximum": 291.54, "gross_charge": 1213.0, "discounted_cash": 909.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 262.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBRTA NJX RX AGT W/VTRC", "code_information": [{"code": "810T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBSEQUENT REPAIR OF NERVE", "code_information": [{"code": "64872", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1486.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/DEB", "code_information": [{"code": "29906", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/EXC", "code_information": [{"code": "29905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FB RMVL", "code_information": [{"code": "29904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FUSION", "code_information": [{"code": "29907", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTEMPORAL DECOMPRESSION", "code_information": [{"code": "61340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1353.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1353.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1353.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1353.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1353.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUCRALFATE 1GM TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311006", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCRALFATE 1GM TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311006", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY HEAD&NECK", "code_information": [{"code": "15876", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY LWR EXTREM", "code_information": [{"code": "15879", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY TRUNK", "code_information": [{"code": "15877", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY UPR EXTREM", "code_information": [{"code": "15878", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUGARS MULTIPLE QUAL", "code_information": [{"code": "84377", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 28.07, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGARS MULTIPLE QUANT", "code_information": [{"code": "84379", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.77, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGARS SINGLE QUAL", "code_information": [{"code": "84376", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 28.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGARS SINGLE QUANT", "code_information": [{"code": "84378", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.77, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULFADIAZINE 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311052", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SULFADIAZINE 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311052", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SULFASALAZIN 500MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311111", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SULFASALAZIN 500MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311111", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SULFASALAZINE 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311110", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SULFASALAZINE 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311110", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUMATRIPTAN 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311191", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUMATRIPTAN 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311191", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUNGLASS FRAMES", "code_information": [{"code": "S0518", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUP FEE ANTIEM,ANTICA,IMMUNO", "code_information": [{"code": "Q0511", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPERIOR VENACAVAGRAM", "code_information": [{"code": "75827", "type": "CPT"}, {"code": "4615828", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1639.89, "gross_charge": 7809.0, "discounted_cash": 5856.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1639.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1344.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 426.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 426.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 426.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 426.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 426.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPERIOR VENACAVAGRAM", "code_information": [{"code": "75827", "type": "CPT"}, {"code": "4915828", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1418.55, "gross_charge": 6755.0, "discounted_cash": 5066.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1418.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1344.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 426.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 426.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 426.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 426.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 426.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPPLIES FOR HOME DELIVERY", "code_information": [{"code": "S8415", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPORT FOR ORGAN DONOR", "code_information": [{"code": "1990", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPRELIN LA IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9226", "type": "HCPCS"}], "standard_charges": [{"minimum": 40518.59, "maximum": 45020.65, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 40518.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 45020.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 45020.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 45020.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 45020.65, 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{"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1016.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF ANTERIOR", "code_information": [{"code": "D3501", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": 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LEVEL III", "code_information": [{"code": "6706013", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"gross_charge": 6464.0, "discounted_cash": 4848.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL III", "code_information": [{"code": "6706013", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"gross_charge": 6464.0, "discounted_cash": 4848.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL III", "code_information": [{"code": "6720503", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"gross_charge": 5479.0, "discounted_cash": 4109.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL III", "code_information": [{"code": "6720503", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"gross_charge": 5479.0, "discounted_cash": 4109.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL III", "code_information": [{"code": "6920404", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"gross_charge": 1585.0, "discounted_cash": 1188.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL III", "code_information": [{"code": "6920404", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"gross_charge": 1585.0, "discounted_cash": 1188.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC NICU 1ST 30MN", "code_information": [{"code": "3110278", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1672.0, "discounted_cash": 1254.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC NICU EA ADD MN", "code_information": [{"code": "3110284", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES ANTERIOR", "code_information": [{"code": "D3471", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES MOLAR", "code_information": [{"code": "D3473", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES PREMOLAR", "code_information": [{"code": "D3472", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY ELECTROCORTICOGRAM", "code_information": [{"code": "95829", "type": "CPT"}], "standard_charges": [{"minimum": 1510.86, "maximum": 1510.86, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1510.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1510.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1510.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1510.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1510.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR LIVER LESION", "code_information": [{"code": "47300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1019.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1019.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1019.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1019.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1019.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR URETHRA POUCH", "code_information": [{"code": "53240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR VULVA LESION", "code_information": [{"code": "56440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY OF GREAT VESSEL", "code_information": [{"code": "33916", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1586.71, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1586.71, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1586.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1586.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1586.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY OF PANCREATIC CYST", "code_information": [{"code": "48500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1021.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1021.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1021.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1021.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1021.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27475", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 650.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 650.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 650.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 650.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 650.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27477", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 724.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 724.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 724.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 724.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 724.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27479", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 954.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 954.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 954.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 954.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 954.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27485", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 667.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 667.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 667.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 667.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 667.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY/SPEECH PROSTHESIS", "code_information": [{"code": "31611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL EXPOSURE PROSTATE", "code_information": [{"code": "55860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 864.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 864.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 864.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 864.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 864.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL MASK", "code_information": [{"code": "A4928", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING ESOPHAGUS", "code_information": [{"code": "43351", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1296.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1296.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1296.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1296.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1296.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING ESOPHAGUS", "code_information": [{"code": "43352", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1041.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1041.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1041.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1041.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1041.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF STOMACH", "code_information": [{"code": "43500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 713.55, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 713.55, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 713.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 713.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 713.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF STOMACH", "code_information": [{"code": "43510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 918.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 918.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 918.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 918.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 918.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF THROAT", "code_information": [{"code": "42955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL PATH LEVEL I", "code_information": [{"code": "88300", "type": "CPT"}, {"code": "4308300", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.01, "gross_charge": 736.0, "discounted_cash": 552.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.81, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PATH LEVEL II", "code_information": [{"code": "88302", "type": "CPT"}, {"code": "4308302", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 146.62, "gross_charge": 594.0, "discounted_cash": 445.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 146.62, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 58.73, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 58.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 58.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 58.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 58.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PATH LEVEL II", "code_information": [{"code": "88302", "type": "CPT"}, {"code": "4358302", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 146.62, "gross_charge": 363.0, "discounted_cash": 272.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 146.62, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 58.73, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 58.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 58.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 58.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 58.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PATH LEVEL III", "code_information": [{"code": "88304", "type": "CPT"}, {"code": "4308403", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 181.22, "gross_charge": 898.0, "discounted_cash": 673.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 181.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 72.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PATH LEVEL IV", "code_information": [{"code": "88305", "type": "CPT"}, {"code": "4305103", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 236.52, "gross_charge": 1495.0, "discounted_cash": 1121.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 236.52, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 118.38, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 118.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 118.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 118.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 118.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PATH LEVEL V", "code_information": [{"code": "88307", "type": "CPT"}, {"code": "4308306", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 402.52, "gross_charge": 2047.0, "discounted_cash": 1535.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 402.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 232.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 232.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 232.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 232.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 232.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PATH LEVEL VI", "code_information": [{"code": "88309", "type": "CPT"}, {"code": "4308309", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 656.15, "gross_charge": 1636.0, "discounted_cash": 1227.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 550.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 342.83, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 342.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 342.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 342.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 342.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 656.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1224.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1224.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1224.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1224.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1224.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1390.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1390.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1390.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1390.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1390.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL REVISION INTESTINE", "code_information": [{"code": "44680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 972.83, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 972.83, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 972.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 972.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 972.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL SIALOLITHOTOMY", "code_information": [{"code": "D7980", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL SITE INFECTION", "code_information": [{"code": "G9312", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL SPECIMEN", "code_information": [{"code": "76098", "type": "CPT"}, {"code": "3070013", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 931.35, "gross_charge": 4435.0, "discounted_cash": 3326.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 931.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 50.18, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL SPECIMEN", "code_information": [{"code": "76098", "type": "CPT"}, {"code": "4906095", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 931.35, "gross_charge": 4435.0, "discounted_cash": 3326.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 931.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 50.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL TRAYS", "code_information": [{"code": "A4550", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.59, "maximum": 42.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 38.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 37.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGIMEND, FETAL", "code_information": [{"code": "C9358", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGIMEND, NEONATAL", "code_information": [{"code": "C9360", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURVEY NOT COMPLETE", "code_information": [{"code": "G0914", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUSCEPTBILTY STDY ENZYME", "code_information": [{"code": "87185", "type": "CPT"}, {"code": "4107036", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.24, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSCEPTIBLTY STUDY MIC/3", "code_information": [{"code": "87186", "type": "CPT"}, {"code": "4107186", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 44.09, "gross_charge": 305.0, "discounted_cash": 228.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 44.09, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPEND BOWEL W/PROSTHESIS", "code_information": [{"code": "44700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 944.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 944.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 944.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 944.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 944.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF BREAST", "code_information": [{"code": "19316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1417.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF TESTIS", "code_information": [{"code": "54620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 997.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF UTERUS", "code_information": [{"code": "58400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 443.04, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 443.04, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 443.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 443.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 443.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF UTERUS", "code_information": [{"code": "58410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 786.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 786.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 786.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 786.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 786.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF VAGINA", "code_information": [{"code": "57280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 947.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 947.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 947.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 947.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 947.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTURE BILE DUCT INJURY", "code_information": [{"code": "47900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1248.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1248.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1248.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1248.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1248.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTURE COMPLICATE WND > 5 CM", "code_information": [{"code": "D7912", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE LARGE INTESTINE", "code_information": [{"code": "44604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 968.31, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 968.31, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 968.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 968.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 968.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTURE SMALL INTESTINE", "code_information": [{"code": "44602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1227.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1227.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1227.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1227.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1227.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTURE SMALL INTESTINE", "code_information": [{"code": "44603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1403.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1403.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1403.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1403.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1403.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SVNT SARSCOV2 ELISA PLSM SRM", "code_information": [{"code": "226U", "type": "CPT"}], "standard_charges": [{"minimum": 42.22, "maximum": 42.22, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWAL FUNC W/CINE/VIDEO+CM STDY", "code_information": [{"code": "74230", "type": "CPT"}, {"code": "4904230", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 378.21, "gross_charge": 1801.0, "discounted_cash": 1350.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 378.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 184.4, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 99.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 99.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 99.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 99.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 99.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWAL FUNC W/CINE/VIDEO+CM STDY", "code_information": [{"code": "74230", "type": "CPT"}, {"code": "5014230", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 378.21, "gross_charge": 1801.0, "discounted_cash": 1350.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 378.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 184.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 99.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 99.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 99.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 99.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 99.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWIVEL ADAPTOR", "code_information": [{"code": "S8186", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SYFLS TST NONTREPONEMAL ANTB", "code_information": [{"code": "65U", "type": "CPT"}], "standard_charges": [{"minimum": 18.09, "maximum": 18.09, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY CERVICAL", "code_information": [{"code": "64802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY DIGITAL ARTERY", "code_information": [{"code": "64820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY SUPFC PALMAR", "code_information": [{"code": "64823", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYNCOPE AND COLLAPSE", "code_information": [{"code": "312", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19945.69, "maximum": 129181.73, "estimated_discounted_cash": 59617.03, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21186.49, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 33940.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 57327.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 116262.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22293.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 122334.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 60322.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 35713.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 37711.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 63698.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 129181.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23540.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 37711.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23540.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 129181.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 63698.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23540.79, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 63698.1, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 37711.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 129181.73, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 98272.56, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 40021.84, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 27799.25, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 19945.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28938.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36466.87, "methodology": "case 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"standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNVISC OR SYNVISC-ONE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7325", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.16, "maximum": 7.95, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 7.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0605", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.18, "maximum": 0.2, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Suicd rsk assessed init eval", "code_information": [{"code": "G8932", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Suicide risk not assessed", "code_information": [{"code": "G8933", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Supply of digital mental health treatment device and initial education and onboarding, per course of treatment that augments a behavioral therapy plan", "code_information": [{"code": "G0552", "type": "HCPCS"}], "standard_charges": [{"minimum": 171.89, "maximum": 196.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 176.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 171.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 196.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 196.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 196.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Surg proc w/in 30 days", "code_information": [{"code": "G8627", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Survive/no stroke post cas", "code_information": [{"code": "G9259", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Survive/no stroke post cea", "code_information": [{"code": "G9261", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Swallow current status", "code_information": [{"code": "G8996", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Swallow d/c status", "code_information": [{"code": "G8998", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Swallow goal status", "code_information": [{"code": "G8997", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "System reason for no beta", "code_information": [{"code": "G9192", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "T CELL ABSOLUTE COUNT", "code_information": [{"code": "86361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 136.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 136.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 15.37, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 15.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 15.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 15.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 15.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T CELL AG RECEPTOR GAMMA", "code_information": [{"code": "81342", "type": "CPT"}, {"code": "7259205", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1029.04, "gross_charge": 2540.0, "discounted_cash": 1905.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1029.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 201.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 201.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T CELLS T4/T8 INC RATIO", "code_information": [{"code": "86360", "type": "CPT"}, {"code": "7256360", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 239.62, "gross_charge": 356.0, "discounted_cash": 267.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 239.62, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T CELLS TOTAL COUNT", "code_information": [{"code": "86359", "type": "CPT"}, {"code": "7256359", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 192.36, "gross_charge": 356.0, "discounted_cash": 267.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 192.36, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T-CELL DEPLETION OF HARVEST", "code_information": [{"code": "38210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 87.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 87.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 87.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 87.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 87.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "T3 FREE", "code_information": [{"code": "84481", "type": "CPT"}, {"code": "4103554", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 86.4, "gross_charge": 301.0, "discounted_cash": 225.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.67, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T3 FREE", "code_information": [{"code": "84481", "type": "CPT"}, {"code": "7253554", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 86.4, "gross_charge": 98.0, "discounted_cash": 73.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.67, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TA MV RPR W/ARTIF CHORD TEND", "code_information": [{"code": "543T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TACRINE HYDROCHLORIDE, 10 MG", "code_information": [{"code": "S0014", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.82, "maximum": 3.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7525", "type": "HCPCS"}], "standard_charges": [{"minimum": 236.84, "maximum": 263.15, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 236.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 263.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 263.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 263.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 263.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS/2", "code_information": [{"code": "80197", "type": "CPT"}, {"code": "7250348", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.97, "gross_charge": 141.0, "discounted_cash": 105.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACTILE BREAST IMG UNI/BI", "code_information": [{"code": "422T", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 80.9, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAH RAD DEBULK/LYMPH REMOVE", "code_information": [{"code": "58954", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2037.48, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2037.48, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2037.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2037.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2037.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAH RAD DISSECT FOR DEBULK", "code_information": [{"code": "58953", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1877.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1877.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1877.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1877.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1877.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TALYMED", "code_information": [{"code": "Q4127", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAMOXIFEN 10 MG", "code_information": [{"code": "S0187", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.2, "maximum": 0.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAMOXIFEN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5311210", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMOXIFEN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5311210", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMSULOSIN .4MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311215", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMSULOSIN .4MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311215", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN EA SEP/ADDL", "code_information": [{"code": "6901103", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 442.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN EA SEP/ADDL", "code_information": [{"code": "6901103", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 442.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN EA SEP/ADDL", "code_information": [{"code": "11103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN SINGLE LES", "code_information": [{"code": "6901102", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN SINGLE LES", "code_information": [{"code": "6901102", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN SINGLE LES", "code_information": [{"code": "11102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TANTALUM RING APPLICATION", "code_information": [{"code": "S8030", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK BI BY INFUSION", "code_information": [{"code": "64489", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK BI INJECTION", "code_information": [{"code": "64488", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNI BY INFUSION", "code_information": [{"code": "64487", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNIL BY INJECTION", "code_information": [{"code": "64486", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 24132.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAPENTADOL", "code_information": [{"code": "80372", "type": "CPT"}, {"code": "7250371", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 1397.0, "discounted_cash": 1047.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TARGET GENOMIC ANALYSIS 51+", "code_information": [{"code": "81455", "type": "CPT"}, {"code": "7270053", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 2919.6, "maximum": 2919.6, "gross_charge": 2385.0, "discounted_cash": 1788.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2919.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2919.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TARGETED CASE MANAGEMENT", "code_information": [{"code": "T1017", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TARGETED CASE MGMT PER MONTH", "code_information": [{"code": "T2023", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TARGETED GENOMIC SEQ ANALYS", "code_information": [{"code": "81445", "type": "CPT"}, {"code": "7270051", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2241.61, "gross_charge": 4435.0, "discounted_cash": 3326.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2241.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 597.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 597.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TARGT SEQ ANLYS 5-50", "code_information": [{"code": "81450", "type": "CPT"}, {"code": "7270052", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2430.9, "gross_charge": 5164.0, "discounted_cash": 3873.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 2430.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 759.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 759.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAS CONGENITAL CAR ANOMAL", "code_information": [{"code": "33741", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TB AG RESPONSE T-CELL SUSP", "code_information": [{"code": "86481", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 382.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 382.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 100.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 100.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB TEST CELL AG RESPONSE", "code_information": [{"code": "86480", "type": "CPT"}, {"code": "4106520", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 316.05, "gross_charge": 327.0, "discounted_cash": 245.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 316.05, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 86.59, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 86.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 86.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 86.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 86.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB TEST CELL AG RESPONSE", "code_information": [{"code": "86480", "type": "CPT"}, {"code": "7258648", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 316.05, "gross_charge": 1535.0, "discounted_cash": 1151.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 316.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 86.59, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 86.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 86.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 86.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 86.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBG-THYROXINE BND GLOBLN", "code_information": [{"code": "84442", "type": "CPT"}, {"code": "7254442", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 75.41, "gross_charge": 256.0, "discounted_cash": 192.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 75.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBO-FILGRASTIM PER1MCGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1447", "type": "HCPCS"}, {"code": "5324441", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.25, "maximum": 0.28, "gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBO-FILGRASTIM PER1MCGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1447", "type": "HCPCS"}, {"code": "5324441", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.25, "maximum": 0.28, "gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBP GENE DETC ABNOR ALLELES", "code_information": [{"code": "81344", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBRF B GRP ANTB 4 PRTN IGG", "code_information": [{"code": "44U", "type": "CPT"}], "standard_charges": [{"minimum": 14.86, "maximum": 14.86, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBRF B GRP ANTB 4 PRTN IGM", "code_information": [{"code": "43U", "type": "CPT"}], "standard_charges": [{"minimum": 14.86, "maximum": 14.86, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS DXA CAL W/I&R FX RISK", "code_information": [{"code": "77089", "type": "CPT"}], "standard_charges": [{"minimum": 41.53, "maximum": 41.53, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS I&R FX RSK QHP", "code_information": [{"code": "77092", "type": "CPT"}], "standard_charges": [{"minimum": 10.38, "maximum": 10.38, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS TECHL CALCULATION ONLY", "code_information": [{"code": "77091", "type": "CPT"}], "standard_charges": [{"minimum": 82.61, "maximum": 82.61, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS TECHL PREP&TRANSMIS DATA", "code_information": [{"code": "77090", "type": "CPT"}], "standard_charges": [{"minimum": 82.61, "maximum": 82.61, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC MEAS 5 BMRK SFDI M-S ALYS", "code_information": [{"code": "61U", "type": "CPT"}], "standard_charges": [{"minimum": 25.1, "maximum": 25.1, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M BICISATE", "code_information": [{"code": "A9557", "type": "HCPCS"}], "standard_charges": [{"minimum": 573.92, "maximum": 637.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 573.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 637.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 637.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 637.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 637.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M EXAMETAZIME", "code_information": [{"code": "A9521", "type": "HCPCS"}], "standard_charges": [{"minimum": 2245.71, "maximum": 2494.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2245.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2494.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2494.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2494.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2494.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT DLVR ENHNCD FIXJ DEV", "code_information": [{"code": "34712", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT IMPL WRLS P-ART PRS SNR", "code_information": [{"code": "33289", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT IMPLTJ C SINS RDCTJ DEV", "code_information": [{"code": "645T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16139.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INS 1CHMBR LDLS PM RA", "code_information": [{"code": "823T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM CMPL", "code_information": [{"code": "795T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RA", "code_information": [{"code": "796T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RV", "code_information": [{"code": "797T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INSJ/RPL PERM LDLS PM", "code_information": [{"code": "33274", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INTRA-C NFS SUPERSAT O2", "code_information": [{"code": "659T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT L VENTR RSTRJ DEV IMPLT", "code_information": [{"code": "643T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT MV ANNULUS RCNSTJ", "code_information": [{"code": "544T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT PLMT&RMVL CEPD PERQ", "code_information": [{"code": "33370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 1CHMBR LDLS PM RA", "code_information": [{"code": "824T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 2CHMBR LDLS PM CMPL", "code_information": [{"code": "798T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL 2CHMBR LDLS PM", "code_information": [{"code": "801T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL1CHMB LDLS PM RA", "code_information": [{"code": "825T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RA", "code_information": [{"code": "802T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RV", "code_information": [{"code": "803T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RA", "code_information": [{"code": "799T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RV", "code_information": [{"code": "800T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL PERM LDLS PM W/IMG", "code_information": [{"code": "33275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL/DBLK ICAR MAS PERQ", "code_information": [{"code": "644T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL OPN", "code_information": [{"code": "806T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL PRQ", "code_information": [{"code": "805T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT TV ANNULUS RCNSTJ", "code_information": [{"code": "545T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCATH RETRV INTRAVASC FB+IMG", "code_information": [{"code": "4917197", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 14968.0, "discounted_cash": 11226.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX A/V NONCOR SUBS", "code_information": [{"code": "4617213", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5043.0, "discounted_cash": 3782.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX A/V NONCOR SUBS", "code_information": [{"code": "4917213", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8459.0, "discounted_cash": 6344.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX CESSATION", "code_information": [{"code": "4617214", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12119.0, "discounted_cash": 9089.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX CESSATION", "code_information": [{"code": "4917214", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11781.0, "discounted_cash": 8835.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX INIT NONCOR ART", "code_information": [{"code": "4617211", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8408.0, "discounted_cash": 6306.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX INIT NONCOR ART", "code_information": [{"code": "4917211", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5954.0, "discounted_cash": 4465.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX INIT NONCOR VEN", "code_information": [{"code": "4617212", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5043.0, "discounted_cash": 3782.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX INIT NONCOR VEN", "code_information": [{"code": "4917212", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8950.0, "discounted_cash": 6712.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/INJ", "code_information": [{"code": "93893", "type": "CPT"}], "standard_charges": [{"minimum": 153.23, "maximum": 329.38, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 329.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 157.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 153.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 329.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 329.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 329.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 329.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/O INJ", "code_information": [{"code": "93892", "type": "CPT"}], "standard_charges": [{"minimum": 153.23, "maximum": 328.92, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 328.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 157.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 153.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 328.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 328.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 328.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 328.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCD VASOREACTIVITY STUDY", "code_information": [{"code": "93890", "type": "CPT"}], "standard_charges": [{"minimum": 309.07, "maximum": 309.07, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 309.07, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 309.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 309.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 309.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 309.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRAN MAGN STIM REDETEMINE", "code_information": [{"code": "90869", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX DELI", "code_information": [{"code": "90868", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX PLAN", "code_information": [{"code": "90867", "type": "CPT"}], "standard_charges": [{"minimum": 343.64, "maximum": 392.98, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 353.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 343.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 392.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY HC PRO", "code_information": [{"code": "99368", "type": "CPT"}], "standard_charges": [{"minimum": 32.85, "maximum": 32.85, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.85, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY PHYS", "code_information": [{"code": "99367", "type": "CPT"}], "standard_charges": [{"minimum": 50.56, "maximum": 50.56, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 50.56, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 50.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 50.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 50.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 50.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/PAT BY HC PROF", "code_information": [{"code": "99366", "type": "CPT"}], "standard_charges": [{"minimum": 39.0, "maximum": 39.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TECHNETIUM TC-99M AUTO WBC", "code_information": [{"code": "A9569", "type": "HCPCS"}], "standard_charges": [{"minimum": 2245.71, "maximum": 2494.68, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2245.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2494.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2494.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2494.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2494.68, "methodology": "fee 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEE CONGTL CARD ANOMALIE", "code_information": [{"code": "93315", "type": "CPT"}, {"code": "4603315", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 677.57, "maximum": 774.86, "gross_charge": 4017.0, "discounted_cash": 3012.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 697.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 677.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEE W OR W/O FOL W/CONT, MON", "code_information": [{"code": "C8927", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEE W OR W/O FOL W/CONT,CONG", "code_information": [{"code": "C8926", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEE W OR WO CM+PROBE PLCMT+RPT", "code_information": [{"code": "C8925", "type": "HCPCS"}, {"code": "4608925", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 2197.86, "maximum": 2197.86, "gross_charge": 10466.0, "discounted_cash": 7849.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2197.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELAVANCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3095", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.4, "maximum": 7.11, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELEHEALTH FACILITY FEE", "code_information": [{"code": "Q3014", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELEHEALTH INPT PHARM MGMT", "code_information": [{"code": "G0459", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELEMONITORING/HOME PER MNTH", "code_information": [{"code": "S9110", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELEPH EVAL SNGL CHMB PM", "code_information": [{"code": "93293", "type": "CPT"}, {"code": "4603293", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "gross_charge": 313.0, "discounted_cash": 234.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELESCOPIC INTRAOCULAR LENS", "code_information": [{"code": "C1840", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TELETHER ISODOSE CMPLEX", "code_information": [{"code": "77307", "type": "CPT"}, {"code": "5107315", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1040.66, "gross_charge": 1642.0, "discounted_cash": 1231.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1040.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 501.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELETHER ISODOSE SIMPLE", "code_information": [{"code": "77306", "type": "CPT"}, {"code": "5107305", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 557.55, "gross_charge": 2072.0, "discounted_cash": 1554.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 538.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 501.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMOZOLOMIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9328", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.35, "maximum": 10.39, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMP ANCHORAGE DEV W FLAP", "code_information": [{"code": "D7293", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMP ANCHORAGE DEV W/O FLAP", "code_information": [{"code": "D7294", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMP FML IU VALVE-PMP RPLCMT", "code_information": [{"code": "597T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMP FML IU VLV-PMP 1ST INSJ", "code_information": [{"code": "596T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMP TRANSCUTNEOUS PACNG", "code_information": [{"code": "92953", "type": "CPT"}, {"code": "4612953", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 820.02, "gross_charge": 1179.0, "discounted_cash": 884.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 738.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 717.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 820.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 820.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 820.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMPERATURE GRADIENT STUDIES", "code_information": [{"code": "93740", "type": "CPT"}], "standard_charges": [{"minimum": 11.13, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMPLATE MANDBLR PREBNT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 708.96, "maximum": 708.96, "gross_charge": 3376.0, "discounted_cash": 2532.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 708.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMPORAL ARTERY PROCEDURE", "code_information": [{"code": "37609", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 719.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMPR", "code_information": [{"code": "278T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMSIROLIMUS INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9330", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.04, "maximum": 26.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 24.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON ANKLE PRESUTURED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4028822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2061.99, "maximum": 2061.99, "gross_charge": 9819.0, "discounted_cash": 7364.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2061.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON EXCISION PALM/FINGER", "code_information": [{"code": "26145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON LENGTHENING", "code_information": [{"code": "26476", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON LNGTH UPR A/E EA TDN", "code_information": [{"code": "24305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON SHORTENING", "code_information": [{"code": "26477", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON TRANSFER WITH GRAFT", "code_information": [{"code": "26492", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [{"code": "557", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49368.05, "maximum": 62210.41, "estimated_discounted_cash": 86713.57, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49368.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 62210.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC", "code_information": [{"code": "558", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29656.03, "maximum": 37370.59, "estimated_discounted_cash": 64217.95, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29656.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37370.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENECTEPLASE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3101", "type": "HCPCS"}, {"code": "5324431", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 155.0, "maximum": 172.22, "gross_charge": 792.0, "discounted_cash": 594.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 172.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 172.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 172.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 172.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENECTEPLASE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3101", "type": "HCPCS"}, {"code": "5324431", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 155.0, "maximum": 172.22, "gross_charge": 792.0, "discounted_cash": 594.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 172.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 172.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 172.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 172.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENIPOSIDE, 50 MG", "code_information": [{"code": "Q2017", "type": "HCPCS"}], "standard_charges": [{"minimum": 2560.84, "maximum": 2845.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2560.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2845.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2845.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2845.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2845.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENODESIS BICEPS TDN AT ELBW", "code_information": [{"code": "24340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOFOVIR 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311245", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TENOFOVIR 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311245", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TENOFOVIR LIQ CHROM UR QUAN", "code_information": [{"code": "25U", "type": "CPT"}], "standard_charges": [{"minimum": 85.77, "maximum": 85.77, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 85.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 85.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOGLIDE TENDON PROT, CM2", "code_information": [{"code": "C9356", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS TRICEPS", "code_information": [{"code": "24332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOPLASTY ELBOW TO SHO 1", "code_information": [{"code": "24320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENSIX, 1CM", "code_information": [{"code": "Q4146", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TERAZOSIN 1MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311250", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TERAZOSIN 1MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311250", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TERAZOSIN 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311252", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TERAZOSIN 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311252", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TERBUTALINE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311260", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TERBUTALINE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311260", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TERBUTALINE SULF COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7680", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.02, "maximum": 0.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERBUTALINE SULF COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7681", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.25, "maximum": 14.72, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERIPARATIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3110", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.62, "maximum": 52.91, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 47.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 52.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 52.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 52.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 52.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERT GENE TARGETED SEQ ALYS", "code_information": [{"code": "81345", "type": "CPT"}], "standard_charges": [{"minimum": 185.2, "maximum": 185.2, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR BLOOD FLOW IN GRAFT", "code_information": [{"code": "15860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEST FOR G6PD ENZYME", "code_information": [{"code": "82960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 30.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR URINE CYSTINES", "code_information": [{"code": "82615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 41.65, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.41, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST RBC PROTOPORPHYRIN", "code_information": [{"code": "84203", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 43.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH 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{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 28.07, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST URINE FOR PORPHYRINS", "code_information": [{"code": "84119", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 43.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 10.6, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 10.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 10.6, "methodology": "fee 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4.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTES PROCEDURES WITH CC/MCC", "code_information": [{"code": "711", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11965.59, "maximum": 88007.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25524.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 79206.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 19519.94, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42178.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26858.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 83343.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 44381.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20539.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 88007.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 46865.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28361.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21689.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 88007.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 46865.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28361.29, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21689.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 46865.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21689.05, "methodology": "case rate"}, {"payer_name": "BLUE 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HEALTHCARE OPTIONS", "standard_charge_dollar": 87184.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TESTES PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "712", "type": "MS-DRG"}], "standard_charges": [{"minimum": 36512.24, "maximum": 46010.35, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 36512.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46010.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TESTICULAR VASC FLOW", "code_information": [{"code": "78761", "type": "CPT"}, {"code": "5208762", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 573.93, "gross_charge": 2733.0, "discounted_cash": 2049.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", 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"plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE PELLET 75 MG", "code_information": [{"code": "S0189", "type": "HCPCS"}], "standard_charges": [{"minimum": 107.87, "maximum": 119.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", 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"TESTOSTERONE RESPONSE PANEL", "code_information": [{"code": "80414", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 263.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 263.38, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 72.16, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 72.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 72.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 72.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 72.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 51.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 51.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE TOTAL", "code_information": [{"code": "84403", "type": "CPT"}, {"code": "4104403", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 131.69, "gross_charge": 730.0, "discounted_cash": 547.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 131.69, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.08, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.81, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE UNDECANOATE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3145", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.86, "maximum": 2.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TETANUS AB", "code_information": [{"code": "86774", "type": "CPT"}, {"code": "7256774", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 75.48, "gross_charge": 400.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 75.48, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"standard_charge_dollar": 740.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 740.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TETANUS IG UPTO 250U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1670", "type": "HCPCS"}, {"code": "5324499", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 533.7, "maximum": 593.0, "gross_charge": 2418.0, "discounted_cash": 1813.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 533.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 593.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS 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"code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311310", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TGFBI GENE COMMON VARIANTS", "code_information": [{"code": "81333", "type": "CPT"}], "standard_charges": [{"minimum": 137.0, "maximum": 137.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TGSAP NSM LUNG NEO DNA&RNA23", "code_information": [{"code": "22U", "type": "CPT"}], "standard_charges": [{"minimum": 1950.0, "maximum": 1950.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1950.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1950.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TGSAP SL OR NEO DNA523&RNA55", "code_information": [{"code": "379U", "type": "CPT"}], "standard_charges": [{"minimum": 3288.51, "maximum": 3288.51, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3288.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3288.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THAW CRYOPRSVRD REPROD TISS", "code_information": [{"code": "89354", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THAW PRESERVED STEM CELLS", "code_information": [{"code": "38208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for 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coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED EMBRYO", "code_information": [{"code": "89352", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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[{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE", "code_information": [{"code": "80198", "type": "CPT"}, {"code": "4102137", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.16, "gross_charge": 324.0, "discounted_cash": 243.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 72.16, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.77, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE 100MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311385", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE 100MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311385", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE 200MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311392", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE 200MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311392", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE 300MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311396", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE 300MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311396", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE200MG XR24CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311409", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 20.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE200MG XR24CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311409", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 20.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE400MG XR24TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311405", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE400MG XR24TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311405", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE80MG/15ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316433", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THEOPHYLLINE80MG/15ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316433", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THER BEHAV SVC, PER 15 MIN", "code_information": [{"code": "H2019", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.48, "maximum": 16.56, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER FOSTERCARE CHILD /MONTH", "code_information": [{"code": "S5146", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER FX NASAL INF TURBINATE", "code_information": [{"code": "30930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10287.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1154.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER INJECTION CARP TUNNEL", "code_information": [{"code": "20526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ 1ST 15 MIN", "code_information": [{"code": "97129", "type": "CPT"}], "standard_charges": [{"minimum": 46.65, "maximum": 53.35, "estimated_discounted_cash": 231.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 46.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 53.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 53.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 53.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ EA ADDL 15 MIN", "code_information": [{"code": "97130", "type": "CPT"}], "standard_charges": [{"minimum": 45.29, "maximum": 51.8, "estimated_discounted_cash": 577.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 46.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 45.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER NOT ASSESSED ANNUALLY", "code_information": [{"code": "G8855", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THER SPI PNXR CSF FLUOR/CT", "code_information": [{"code": "62329", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 18328.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER SPI PNXR DRG CSF", "code_information": [{"code": "62272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 183.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERAPEUTC APHERESIS RBC", "code_information": [{"code": "4506512", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5661.0, "discounted_cash": 4245.75, "setting": "both", "billing_class": "facility"}]}, {"description": "THERAPEUTIC ACTIVITIES", "code_information": [{"code": "97530", "type": "CPT"}], "standard_charges": [{"minimum": 24.78, "maximum": 93.87, "estimated_discounted_cash": 442.54, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 84.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.87, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC APHERESIS", "code_information": [{"code": "4546514", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7783.0, "discounted_cash": 5837.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THERAPEUTIC EXERCISES", "code_information": [{"code": "97110", "type": "CPT"}], "standard_charges": [{"minimum": 23.1, "maximum": 71.03, "estimated_discounted_cash": 415.33, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 63.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 62.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 71.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 71.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 71.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PNEUMOTHORAX", "code_information": [{"code": "32960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 232.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 232.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding 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"percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PROCD STRG ENDUR", "code_information": [{"code": "G0237", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.81, "maximum": 34.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 34.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 34.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 34.31, "methodology": "fee 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145.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKIN 6SQ CM XSML PR SQCM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025536", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 145.11, "maximum": 145.11, "gross_charge": 691.0, "discounted_cash": 518.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 145.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKIN LRG 39SQ CM PR SQ CM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025535", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 125.37, "maximum": 125.37, "gross_charge": 597.0, "discounted_cash": 447.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 125.37, "methodology": "fee 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"facility"}]}, {"description": "THERASKIN PER SQ CM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025532", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 47.25, "maximum": 47.25, "gross_charge": 225.0, "discounted_cash": 168.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKN XLG 7.6X15.2CM PRSQCM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025538", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 36.75, "maximum": 36.75, "gross_charge": 175.0, "discounted_cash": 131.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKN 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"fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 29.67, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 29.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 29.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 29.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 29.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIETHYLPERAZINE MALEATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3280", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.28, "maximum": 4.76, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIETHYLPERAZINE MALEATE10MG", "code_information": [{"code": "Q0174", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.63, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 59.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.26, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIOPURINE/2", "code_information": [{"code": "80375", "type": "CPT"}, {"code": "7252555", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 436.0, "discounted_cash": 327.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIORIDAZINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311537", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "THIORIDAZINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311537", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "THIORIDAZINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311548", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THIORIDAZINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311548", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THIORIDAZINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311552", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THIORIDAZINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311552", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THIOTHIXENE 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311594", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THIOTHIXENE 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311594", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THIOTHIXENE 1MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311583", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THIOTHIXENE 1MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311583", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THIOTHIXENE 2MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311587", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THIOTHIXENE 2MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311587", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THIOTHIXENE 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311591", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "THIOTHIXENE 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311591", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43336", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43337", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACENTSIS W/IMAGING", "code_information": [{"code": "4912555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3678.0, "discounted_cash": 2758.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACENTSIS W/IMAGING", "code_information": [{"code": "5052555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3678.0, "discounted_cash": 2758.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACENTSIS W/IMAGING", "code_information": [{"code": "5062555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3678.0, "discounted_cash": 2758.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC AORTIC GRAFT", "code_information": [{"code": "33875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1986.64, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1986.64, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1986.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1986.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1986.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 554.11, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 554.11, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 554.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 554.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 554.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38381", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 808.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 808.5, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 808.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 808.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 808.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 657.67, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 657.67, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 657.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 657.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 657.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACIC MYELO LUMB INJ", "code_information": [{"code": "4902302", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9580.0, "discounted_cash": 7185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC MYELO LUMB INJ", "code_information": [{"code": "4912303", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7025.0, "discounted_cash": 5268.75, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC W/O SERL COMP", "code_information": [{"code": "75600", "type": "CPT"}, {"code": "4915601", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 2861.66, "gross_charge": 12085.0, "discounted_cash": 9063.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2537.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1460.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 479.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 479.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 479.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 479.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 479.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC W/SERL COMPLT", "code_information": [{"code": "75605", "type": "CPT"}, {"code": "4915606", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 4770.37, "gross_charge": 16863.0, "discounted_cash": 12647.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3541.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1362.3, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 441.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 441.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 441.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 441.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 441.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOABDOMINAL GRAFT", "code_information": [{"code": "33877", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3388.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3388.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3388.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3388.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3388.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOP W/ESOPH MUSC EXC", "code_information": [{"code": "32665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1181.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1181.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1181.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1181.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1181.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY BILOBECTOMY", "code_information": [{"code": "32670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY CONTRL BLEEDING", "code_information": [{"code": "32654", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1103.46, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1103.46, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1103.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1103.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1103.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY DIAGNOSTIC", "code_information": [{"code": "32601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 311.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 311.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 311.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 311.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 311.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY FOR LVRS", "code_information": [{"code": "32672", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY LYMPH NODE EXC", "code_information": [{"code": "32674", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY PNEUMONECTOMY", "code_information": [{"code": "32671", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REM TOTL CORTEX", "code_information": [{"code": "32652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1561.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1561.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1561.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1561.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1561.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOV FB/FIBRIN", "code_information": [{"code": "32653", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1006.62, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1006.62, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1006.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1006.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1006.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE CORTEX", "code_information": [{"code": "32651", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1038.36, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1038.36, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1038.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1038.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1038.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE SEGMENT", "code_information": [{"code": "32669", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY RESECT BULLAE", "code_information": [{"code": "32655", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 931.27, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 931.27, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 931.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 931.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 931.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/ TH NRV EXC", "code_information": [{"code": "32664", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 860.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 860.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 860.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 860.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 860.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX INFILTRATE", "code_information": [{"code": "32607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX MED SPACE", "code_information": [{"code": "32606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 24845.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 468.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 468.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 468.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 468.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 468.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX NODULE", "code_information": [{"code": "32608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX PLEURA", "code_information": [{"code": "32609", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 10359.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/LOBECTOMY", "code_information": [{"code": "32663", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1384.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1384.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1384.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1384.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1384.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/MEDIAST EXC", "code_information": [{"code": "32662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PERICARD EXC", "code_information": [{"code": "32661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 829.44, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 829.44, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 829.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 829.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 829.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURECTOMY", "code_information": [{"code": "32656", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 826.85, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 826.85, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 826.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 826.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 826.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURODESIS", "code_information": [{"code": "32650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 691.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 691.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 691.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 691.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 691.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/SAC DRAINAGE", "code_information": [{"code": "32659", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 758.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 758.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 758.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 758.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 758.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/SAC FB REMOVE", "code_information": [{"code": "32658", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 744.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 744.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 744.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 744.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 744.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/THYMUS RESECT", "code_information": [{"code": "32673", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT ADDL", "code_information": [{"code": "32667", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT DIAG", "code_information": [{"code": "32668", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/WEDGE RESECT", "code_information": [{"code": "32666", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY WBX SAC", "code_information": [{"code": "32604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 486.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 486.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 486.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 486.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 486.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/FLAP DRAINAGE", "code_information": [{"code": "32036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 752.95, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 752.95, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 752.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 752.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 752.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/RIB RESECTION", "code_information": [{"code": "32035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 694.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 694.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 694.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 694.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 694.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORAX STEREO RAD TARGETW/TX", "code_information": [{"code": "32701", "type": "CPT"}], "standard_charges": [{"minimum": 51420.0, "maximum": 57137.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 51420.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 57137.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36906", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROAT MUSCLE SURGERY", "code_information": [{"code": "43030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROAT X-RAY & FLUOROSCOPY", "code_information": [{"code": "70370", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 179.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 179.37, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 83.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 83.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 83.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 83.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 83.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMB NONCOR ADD VESSLS", "code_information": [{"code": "4617185", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10160.0, "discounted_cash": 7620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMB NONCOR ADD VESSLS", "code_information": [{"code": "4914101", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21383.0, "discounted_cash": 16037.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMB NONCOR INITL VSL", "code_information": [{"code": "4617184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19715.0, "discounted_cash": 14786.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMB NONCOR INITL VSL", "code_information": [{"code": "4914100", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10996.0, "discounted_cash": 8247.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMB NONCOR SECONDARY", "code_information": [{"code": "4617186", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 22798.0, "discounted_cash": 17098.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMB NONCOR SECONDARY", "code_information": [{"code": "4914102", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21383.0, "discounted_cash": 16037.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMBIN TIME PLASMA/3", "code_information": [{"code": "85670", "type": "CPT"}, {"code": "7255670", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.46, "gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 29.46, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME PLASMA/4", "code_information": [{"code": "85670", "type": "CPT"}, {"code": "7258567", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.46, "gross_charge": 237.0, "discounted_cash": 177.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 29.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME TITER", "code_information": [{"code": "85675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.97, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.58, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBLYTIC ART/VEN THERAPY", "code_information": [{"code": "37213", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC ART THERAPY", "code_information": [{"code": "37211", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC THERAPY STROKE", "code_information": [{"code": "37195", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3265.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC VENOUS THERAPY", "code_information": [{"code": "37212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOMODULIN", "code_information": [{"code": "85337", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 53.14, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 14.56, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 14.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 14.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 14.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 14.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOPLASTIN INHIBITION", "code_information": [{"code": "85705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 49.09, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.77, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOXANE URINE", "code_information": [{"code": "84431", "type": "CPT"}, {"code": "7254428", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.81, "gross_charge": 352.0, "discounted_cash": 264.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 85.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THUMB FUSION WITH GRAFT", "code_information": [{"code": "26820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THUMB FUSION WITH GRAFT", "code_information": [{"code": "26842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THUMB TENDON TRANSFER", "code_information": [{"code": "26510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THXP APHERESIS W/HDL DELIP", "code_information": [{"code": "342T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROGLOBULIN", "code_information": [{"code": "84432", "type": "CPT"}, {"code": "7254432", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 81.91, "gross_charge": 219.0, "discounted_cash": 164.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 81.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.44, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROGLOBULIN AB", "code_information": [{"code": "86800", "type": "CPT"}, {"code": "4106640", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 81.1, "gross_charge": 426.0, "discounted_cash": 319.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 81.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROGLOBULIN AB", "code_information": [{"code": "86800", "type": "CPT"}, {"code": "7256175", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 81.1, "gross_charge": 426.0, "discounted_cash": 319.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 81.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROGLOBULIN AB/2", "code_information": [{"code": "86800", "type": "CPT"}, {"code": "7256800", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 81.1, "gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 81.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROGLOBULIN/2", "code_information": [{"code": "84432", "type": "CPT"}, {"code": "7254433", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 81.91, "gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 81.91, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.44, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID C/M IMG WHOL BDY", "code_information": [{"code": "78018", "type": "CPT"}, {"code": "5208018", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 772.72, "gross_charge": 2590.0, "discounted_cash": 1942.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 543.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 772.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 353.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 353.63, "methodology": "fee 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"methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 23638.95, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 19641.73, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 63476.85, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 48493.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 100273.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 126357.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "627", "type": "MS-DRG"}], "standard_charges": [{"minimum": 44102.22, "maximum": 55574.74, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44102.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55574.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROTROPIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3240", "type": "HCPCS"}], "standard_charges": [{"minimum": 1904.69, "maximum": 2116.32, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1904.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2116.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2116.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2116.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2116.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROTROPIN RECEPTOR AB", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "7253528", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.03, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROXINE FREE", "code_information": [{"code": "84439", "type": "CPT"}, {"code": "4103531", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.99, "gross_charge": 130.0, "discounted_cash": 97.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 45.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROXINE FREE", "code_information": [{"code": "84439", "type": "CPT"}, {"code": "7253534", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.99, "gross_charge": 130.0, "discounted_cash": 97.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 45.99, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROXINE FREE/2", "code_information": [{"code": "84439", "type": "CPT"}, {"code": "7255310", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.99, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 45.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROXINE TOTAL", "code_information": [{"code": "84436", "type": "CPT"}, {"code": "4104436", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.08, "gross_charge": 232.0, "discounted_cash": 174.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 35.08, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROXINE TOTAL", "code_information": [{"code": "84436", "type": "CPT"}, {"code": "7254436", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.08, "gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 35.08, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIAGABINE", "code_information": [{"code": "80199", "type": "CPT"}, {"code": "7250314", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 89.02, "gross_charge": 168.0, "discounted_cash": 126.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 89.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIAGABINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311630", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TIAGABINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311630", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TIB/PER REVASC ADD-ON", "code_information": [{"code": "37232", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC STENT & ATHER", "code_information": [{"code": "37231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC STNT & ATHER", "code_information": [{"code": "37235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/ATHER", "code_information": [{"code": "37229", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/STENT", "code_information": [{"code": "37230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/TLA", "code_information": [{"code": "37228", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIBIA/FIBULA 2 VIEWS", "code_information": [{"code": "73590", "type": "CPT"}, {"code": "4903590", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 325.71, "gross_charge": 1551.0, "discounted_cash": 1163.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 325.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.5, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIA/FIBULA 2 VIEWS", "code_information": [{"code": "73590", "type": "CPT"}, {"code": "5013590", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 325.71, "gross_charge": 1551.0, "discounted_cash": 1163.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 325.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.5, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL ARTHROSCOPY/SURGERY", "code_information": [{"code": "29855", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIBIAL ARTHROSCOPY/SURGERY", "code_information": [{"code": "29856", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIBPER REVASC W/ATHER ADD-ON", "code_information": [{"code": "37233", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TICAGRELOR 90MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311679", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 30.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TICAGRELOR 90MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311679", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 30.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TIGHTROPE RT W/FLIPCUTR II/III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4018081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 489.72, "maximum": 489.72, "gross_charge": 2332.0, "discounted_cash": 1749.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 489.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TILT TABLE SCAN PROC", "code_information": [{"code": "93660", "type": "CPT"}, {"code": "4601130", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52472.0, "gross_charge": 2055.0, "discounted_cash": 1541.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 191.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 638.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 620.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 709.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47222.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52472.0, "methodology": "per diem"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 191.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 191.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 191.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 191.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TINNITUS ASSESSMENT", "code_information": [{"code": "92625", "type": "CPT"}], "standard_charges": [{"minimum": 72.22, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 72.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 72.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 72.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 72.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 72.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TINZAPARIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1655", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.14, "maximum": 3.49, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIOTROPIUM CP18MCG5DS IH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5332714", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 292.0, "discounted_cash": 219.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIOTROPIUM CP18MCG5DS IH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5332714", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 292.0, "discounted_cash": 219.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL 1ST SHNT", "code_information": [{"code": "33745", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL EA ADDL", "code_information": [{"code": "33746", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR ADDL 30 SQ CM", "code_information": [{"code": "14302", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR ANY 30.1-60 SQ CM", "code_information": [{"code": "14301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR E/N/E/L 10 SQ CM/<", "code_information": [{"code": "14060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR E/N/E/L10.1-30SQCM", "code_information": [{"code": "14061", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR F/C/C/M/N/A/G/H/F", "code_information": [{"code": "14040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15890.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR F/C/C/M/N/A/G/H/F", "code_information": [{"code": "14041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR S/A/L 10 SQ CM/<", "code_information": [{"code": "14020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR S/A/L 10.1-30 SQCM", "code_information": [{"code": "14021", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR TRUNK 10 SQ CM/<", "code_information": [{"code": "14000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR TRUNK 10.1-30SQCM", "code_information": [{"code": "14001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 672.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISAGENLECLEUCEL CAR-POS T", "code_information": [{"code": "Q2042", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISS CONNECTIVE HUMAN", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "8240407", "type": "CDM"}], "standard_charges": [{"minimum": 1335.81, "maximum": 1335.81, "gross_charge": 6361.0, "discounted_cash": 4770.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1335.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS CULT ADD STUDIES", "code_information": [{"code": "87253", "type": "CPT"}, {"code": "7257257", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 103.0, "gross_charge": 117.0, "discounted_cash": 87.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 103.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.22, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS CULT INOC/OBSERV", "code_information": [{"code": "87252", "type": "CPT"}, {"code": "7257227", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 132.93, "gross_charge": 149.0, "discounted_cash": 111.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 132.93, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS CULT INOC/OBSERV/5", "code_information": [{"code": "87252", "type": "CPT"}, {"code": "7257252", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 132.93, "gross_charge": 408.0, "discounted_cash": 306.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 132.93, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.42, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS EX MOLECUL STUDY ADD-ON", "code_information": [{"code": "88388", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TISS EXAM MOLECULAR STUDY", "code_information": [{"code": "88387", "type": "CPT"}], "standard_charges": [{"minimum": 8.03, "maximum": 8.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS MATRIX ACELL DERM", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "8243792", "type": "CDM"}], "standard_charges": [{"minimum": 13243.65, "maximum": 13243.65, "gross_charge": 63065.0, "discounted_cash": 47298.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 13243.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS MATRX ULCER PER 1CM", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "8243794", "type": "CDM"}], "standard_charges": [{"minimum": 129.57, "maximum": 129.57, "gross_charge": 617.0, "discounted_cash": 462.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 129.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS REGEN EDENT NONRESORB", "code_information": [{"code": "D7957", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISS REGEN EDENT RESORB", "code_information": [{"code": "D7956", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISS TRANSGLUTAMINASE AB/2", "code_information": [{"code": "86364", "type": "CPT"}, {"code": "7253562", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS TRANSGLUTAMINASE AB/3", "code_information": [{"code": "86364", "type": "CPT"}, {"code": "7253603", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS TRANSGLUTAMINASE AB/5", "code_information": [{"code": "86364", "type": "CPT"}, {"code": "7253979", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 11.53, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS XPNDR PLMT BRST RCNSTJ", "code_information": [{"code": "19357", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2528.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISSUE ATTACH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8177580", "type": "CDM"}], "standard_charges": [{"minimum": 2286.69, "maximum": 2286.69, "gross_charge": 10889.0, "discounted_cash": 8166.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2286.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULT BONE MARROW", "code_information": [{"code": "88237", "type": "CPT"}, {"code": "7258238", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 644.12, "gross_charge": 416.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 644.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 55.83, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 55.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 55.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 55.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 55.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 143.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 143.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE LYMPHOCYTE", "code_information": [{"code": "88230", "type": "CPT"}, {"code": "7018230", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 594.11, "gross_charge": 2155.0, "discounted_cash": 1616.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 594.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 48.38, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 48.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 48.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 48.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 48.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 116.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 116.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE PLACENTA", "code_information": [{"code": "88235", "type": "CPT"}, {"code": "7258241", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 750.95, "gross_charge": 1914.0, "discounted_cash": 1435.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 750.95, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 150.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 150.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE SKIN/BIOPSY/2", "code_information": [{"code": "88233", "type": "CPT"}, {"code": "7258232", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 717.7, "gross_charge": 2122.0, "discounted_cash": 1591.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 717.7, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 140.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 140.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE TUMOR", "code_information": [{"code": "88239", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 752.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 752.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 206.12, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 206.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 206.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 206.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 206.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 147.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 147.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "8177585", "type": "CDM"}], "standard_charges": [{"minimum": 3117.87, "maximum": 3117.87, "gross_charge": 14847.0, "discounted_cash": 11135.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3117.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE GRIND FOR CULTURE", "code_information": [{"code": "87176", "type": "CPT"}, {"code": "4108717", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.0, "gross_charge": 130.0, "discounted_cash": 97.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.22, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE MATRIX ANY TYPE", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4025531", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2881.41, "maximum": 2881.41, "gross_charge": 13721.0, "discounted_cash": 10290.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2881.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE MATRIX ANY TYPE", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4025531", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2881.41, "maximum": 2881.41, "gross_charge": 13721.0, "discounted_cash": 10290.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2881.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE REGEN NON-RESORBABLE", "code_information": [{"code": "D6107", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISSUE REGEN RESORBABLE", "code_information": [{"code": "D6106", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIZANIDINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311692", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TIZANIDINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311692", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TLH UTERUS 250 G OR LESS", "code_information": [{"code": "58570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 889.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 889.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 889.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 889.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 889.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TLH UTERUS OVER 250 G", "code_information": [{"code": "58572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1100.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1100.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1100.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1100.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1100.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TLH W/T/O 250 G OR LESS", "code_information": [{"code": "58571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 56315.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 973.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 973.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 973.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 973.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 973.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TLH W/T/O UTERUS OVER 250 G", "code_information": [{"code": "58573", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 68118.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1240.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1240.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1240.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1240.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1240.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TM JOINTS BILATERAL", "code_information": [{"code": "70330", "type": "CPT"}, {"code": "4900330", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 262.71, "gross_charge": 1251.0, "discounted_cash": 938.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 262.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 112.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TM JOINTS BILATERAL", "code_information": [{"code": "70330", "type": "CPT"}, {"code": "5010330", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 262.71, "gross_charge": 1251.0, "discounted_cash": 938.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 262.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 112.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TM JOINTS UNILATERAL", "code_information": [{"code": "70328", "type": "CPT"}, {"code": "4900328", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 143.43, "gross_charge": 683.0, "discounted_cash": 512.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 143.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TM JOINTS UNILATERAL", "code_information": [{"code": "70328", "type": "CPT"}, {"code": "5010328", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 143.43, "gross_charge": 683.0, "discounted_cash": 512.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 143.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 34.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMA/TMAO PRFL MS/MS UR ALG", "code_information": [{"code": "256U", "type": "CPT"}], "standard_charges": [{"minimum": 159.95, "maximum": 159.95, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 159.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 159.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DEBRIDEMENT", "code_information": [{"code": "D7877", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DISC REPOSIT", "code_information": [{"code": "D7874", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DISCECTOMY", "code_information": [{"code": "D7876", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY LYSIS ADHESN", "code_information": [{"code": "D7873", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY SYNOVECTOMY", "code_information": [{"code": "D7875", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ASPIRATION JOINT FLUID", "code_information": [{"code": "D7870", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ CUTTING INTO JOINT", "code_information": [{"code": "D7860", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ CUTTING OF A MUSCLE", "code_information": [{"code": "D7856", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ DIAGNOSTIC ARTHROSCOPY", "code_information": [{"code": "D7872", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ EXCISN OF JOINT MEMBRANE", "code_information": [{"code": "D7854", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ MANIPULATION UNDER ANEST", "code_information": [{"code": "D7830", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ MENISCECTOMY", "code_information": [{"code": "D7850", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ OPEN REDUCT-DISLOCATION", "code_information": [{"code": "D7810", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ RECONSTRUCTION", "code_information": [{"code": "D7858", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ REPAIR OF JOINT DISC", "code_information": [{"code": "D7852", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ RESHAPING COMPONENTS", "code_information": [{"code": "D7865", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMPST AUTO TUBE DLVR SYS", "code_information": [{"code": "583T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMVI PERCUTANEOUS APPROACH", "code_information": [{"code": "483T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMVI TRANSTHORACIC EXPOSURE", "code_information": [{"code": "484T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TNOT OPN ELBW TO SHO EA TDN", "code_information": [{"code": "24310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "4104468", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.2, "gross_charge": 335.0, "discounted_cash": 251.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.2, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "7254465", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.2, "gross_charge": 342.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7685", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.1, "maximum": 93.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 84.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 93.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 93.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 93.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 93.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7682", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.6, "maximum": 16.22, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 16.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN/2", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "4104469", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.2, "gross_charge": 342.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.2, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN/2", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "7254466", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.2, "gross_charge": 342.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.2, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN/3", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "4104471", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.2, "gross_charge": 342.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.2, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN/3", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "7254468", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.2, "gross_charge": 85.0, "discounted_cash": 63.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 82.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOCILIZUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3262", "type": "HCPCS"}, {"code": "5324791", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 5.14, "maximum": 5.71, "gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOCILIZUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3262", "type": "HCPCS"}, {"code": "5324791", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.14, "maximum": 5.71, "gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 5.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOE JOINT TRANSFER", "code_information": [{"code": "26556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2947.95, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2947.95, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2947.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2947.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2947.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOE(S) 2 VIEWS", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "4903660", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 233.52, "gross_charge": 1112.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 233.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 60.21, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOE(S) 2 VIEWS", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "5013660", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 233.52, "gross_charge": 1112.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 233.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 60.21, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOILET SEAT RAISED", "code_information": [{"code": "E0244", "type": "HCPCS"}], "standard_charges": [{"minimum": 52.87, "maximum": 60.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 52.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 60.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 60.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 60.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOLTERODINE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311751", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TOLTERODINE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311751", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TOLTERODINE 2MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311747", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TOLTERODINE 2MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311747", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TOMOSYNTHESIS, MAMMO", "code_information": [{"code": "G0279", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 25.47, "estimated_discounted_cash": 822.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONE DECAY HEARING TEST", "code_information": [{"code": "92563", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 45.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE AND NECK SURGERY", "code_information": [{"code": "41135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2113.08, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2113.08, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2113.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2113.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2113.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE BASE VOL REDUCTION", "code_information": [{"code": "41530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE JAW & NECK SURGERY", "code_information": [{"code": "41155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2823.96, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2823.96, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2823.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2823.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2823.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH JAW SURGERY", "code_information": [{"code": "41150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2165.97, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2165.97, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2165.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2165.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2165.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH NECK SURGERY", "code_information": [{"code": "41153", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2323.76, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2323.76, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2323.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2323.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2323.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE REMOVAL NECK SURGERY", "code_information": [{"code": "41145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2726.91, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2726.91, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2726.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2726.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2726.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE SUSPENSION", "code_information": [{"code": "41512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE TO LIP SURGERY", "code_information": [{"code": "41510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOOTH REIMPLANTATION", "code_information": [{"code": "D7270", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPICAL APP FLUORID EX VRNSH", "code_information": [{"code": "D1208", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.2, "maximum": 20.81, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPICAL FLUORIDE VARNISH", "code_information": [{"code": "99188", "type": "CPT"}, {"code": "6709188", "type": "CDM"}, {"code": "515", "type": "RC"}], "standard_charges": [{"minimum": 20.2, "maximum": 23.1, "gross_charge": 126.0, "discounted_cash": 94.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPICAL FLUORIDE VARNISH", "code_information": [{"code": "D1206", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.45, "maximum": 35.97, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 35.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 35.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 35.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPIRAMATE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311755", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOPIRAMATE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311755", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOPIRAMATE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311754", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TOPIRAMATE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311754", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TOPIRAMATE LVL", "code_information": [{"code": "80201", "type": "CPT"}, {"code": "7254470", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 60.81, "gross_charge": 282.0, "discounted_cash": 211.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 60.81, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPOGRAPHIC BRAIN MAPPING", "code_information": [{"code": "S8040", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TORSEMIDE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311762", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TORSEMIDE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311762", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TORSEMIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311760", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TORSEMIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311760", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TORSION MECHANISM WRIST/ELBO", "code_information": [{"code": "L3891", "type": "HCPCS"}], "standard_charges": [{"minimum": 697.0, "maximum": 797.07, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 717.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 697.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 797.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 797.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 797.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22856", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 76114.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 1NTRSPC LMBR", "code_information": [{"code": "22857", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1708.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1708.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1708.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1708.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1708.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 2ND LVL CRV", "code_information": [{"code": "22858", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 2NTRSPC LMBR", "code_information": [{"code": "22860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOT ESTRADIOL RESPONSE PANEL", "code_information": [{"code": "80415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 284.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 284.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 78.08, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 78.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 78.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 78.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 78.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ARTHROPLASTY", "code_information": [{"code": "27130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 31438.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1420.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1420.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1420.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1420.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1420.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ARTHROPLASTY", "code_information": [{"code": "27132", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1660.95, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1660.95, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1660.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1660.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1660.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP RESURFACING", "code_information": [{"code": "S2118", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HYSTERECTOMY", "code_information": [{"code": "58150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 966.17, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 966.17, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 966.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 966.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 966.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOTAL HYSTERECTOMY", "code_information": [{"code": "58152", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1228.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1228.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1228.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1228.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1228.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE ARTHROPLASTY", "code_information": [{"code": "27447", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 16904.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1526.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1526.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1526.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1526.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1526.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOTAL LUNG LAVAGE", "code_information": [{"code": "32997", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 352.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 352.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 352.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 352.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 352.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOTAZOLINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2670", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.1, "maximum": 3.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 3.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 3.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 3.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 3.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 3.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOURNIQUET FOR DIALYSIS, EA", "code_information": [{"code": "A4929", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOXOPLASMA AB", "code_information": [{"code": "86777", "type": "CPT"}, {"code": "7256773", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.4, "gross_charge": 349.0, "discounted_cash": 261.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 73.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOXOPLASMA AB IGM", "code_information": [{"code": "86778", "type": "CPT"}, {"code": "7256923", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.44, "gross_charge": 251.0, "discounted_cash": 188.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 73.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOXOPLASMA AB/5", "code_information": [{"code": "86777", "type": "CPT"}, {"code": "7256922", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.4, "gross_charge": 83.0, "discounted_cash": 62.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 73.4, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TP53 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81351", "type": "CPT"}], "standard_charges": [{"minimum": 641.85, "maximum": 641.85, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 641.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 641.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TP53 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81353", "type": "CPT"}], "standard_charges": [{"minimum": 308.0, "maximum": 308.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TP53 GENE TRGT SEQ ANALYSIS", "code_information": [{"code": "81352", "type": "CPT"}, {"code": "7251019", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 329.51, "maximum": 329.51, "gross_charge": 2057.0, "discounted_cash": 1542.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 329.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 329.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPA INITI W/IN 4.5 HR", "code_information": [{"code": "G8600", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TPMT GENE COM VARIANTS", "code_information": [{"code": "81335", "type": "CPT"}], "standard_charges": [{"minimum": 174.81, "maximum": 174.81, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPMT NUDT15 GENES", "code_information": [{"code": "34U", "type": "CPT"}], "standard_charges": [{"minimum": 466.17, "maximum": 466.17, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 466.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 466.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV ADJMT", "code_information": [{"code": "53454", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV BI", "code_information": [{"code": "53451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV RMVL EA", "code_information": [{"code": "53453", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV UNI", "code_information": [{"code": "53452", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL FOCAL ABLTJ MAL PRST8", "code_information": [{"code": "655T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL LSR ABLT B9 PRST8 HYPR", "code_information": [{"code": "714T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL PLMT BIODEGRDABL MATRL", "code_information": [{"code": "55874", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 9437.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TR RETINAL LES PRETERM INF", "code_information": [{"code": "67229", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRABECULOPLASTY LASER SURG", "code_information": [{"code": "65855", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 143.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 143.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 143.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 143.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 143.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INT LSR W/SCP", "code_information": [{"code": "622T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INTERNO LASER", "code_information": [{"code": "621T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRABECULOTOMY LSR W/OCT GDN", "code_information": [{"code": "730T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACH SUPPLY NOC", "code_information": [{"code": "S8189", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRACHEO-ESOPHAGOPLASTY CONG", "code_information": [{"code": "43314", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2803.42, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2803.42, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2803.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2803.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2803.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC", "code_information": [{"code": "12", "type": "MS-DRG"}], "standard_charges": [{"minimum": 139979.63, "maximum": 176393.22, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 139979.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 176393.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC", "code_information": [{"code": "11", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49112.14, "maximum": 326926.91, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 144828.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 294231.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 76715.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 51701.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 152392.8, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 54401.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 80721.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 309599.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57446.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 160921.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 85239.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 326926.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57446.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 160921.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 326926.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 85239.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57446.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 85239.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 326926.91, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 160921.85, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 49112.14, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 105266.4, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 138801.88, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 210886.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 181087.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 228194.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC", "code_information": [{"code": "13", "type": "MS-DRG"}], "standard_charges": [{"minimum": 95681.52, "maximum": 120571.63, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 95681.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 120571.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY SHOWER PROTECT", "code_information": [{"code": "A7523", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES", "code_information": [{"code": "4", "type": "MS-DRG"}], "standard_charges": [{"minimum": 83643.02, "maximum": 579528.72, "estimated_discounted_cash": 1115295.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 131862.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 191799.04, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 88055.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 280274.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 201817.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 294913.28, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 92655.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 138750.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 213112.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 97841.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 311418.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 146515.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 213112.26, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 146515.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 97841.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 311418.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 146515.88, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 97841.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 311418.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 213112.26, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 83643.02, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 160765.76, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 241703.08, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 121239.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 459894.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 579528.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACHEOTOMY TUBE CHANGE", "code_information": [{"code": "5501502", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2894.0, "discounted_cash": 2170.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAMADOL 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311770", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAMADOL 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311770", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAMADOL QUANT", "code_information": [{"code": "80373", "type": "CPT"}, {"code": "7250373", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "gross_charge": 1397.0, "discounted_cash": 1047.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANEXAMIC ACID PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3290", "type": "HCPCS"}, {"code": "5324874", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.04, "discounted_cash": 0.03, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANEXAMIC ACID PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3290", "type": "HCPCS"}, {"code": "5324874", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.04, "discounted_cash": 0.03, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANS ECHO PROSTATE VOL", "code_information": [{"code": "76873", "type": "CPT"}, {"code": "5106873", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 353.64, "gross_charge": 1684.0, "discounted_cash": 1263.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 353.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 307.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 198.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 198.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 198.5, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 198.5, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 198.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43333", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSABDOM AMNIOINFUS W/US", "code_information": [{"code": "59070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSAMINASE-SGPT (ALT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "4104460", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.01, "gross_charge": 136.0, "discounted_cash": 102.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSAMINASE-SGPT (ALT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "7254460", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.01, "gross_charge": 121.0, "discounted_cash": 90.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSBRONCH LUNG BIOPSY", "code_information": [{"code": "5500665", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2519.0, "discounted_cash": 1889.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE OF VSD", "code_information": [{"code": "93581", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 23915.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16139.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1366.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21527.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 20912.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23915.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23915.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23915.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1366.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1366.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1366.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1366.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH EMBOLIZ MICROSPHER", "code_information": [{"code": "S2095", "type": "HCPCS"}], "standard_charges": [{"minimum": 6694.0, "maximum": 6694.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH INS/RPL PERM LDLS PM", "code_information": [{"code": "4610387", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 83429.0, "discounted_cash": 62571.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSCATH INTRAOP MICROINF", "code_information": [{"code": "C9759", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH MTRAL VLVE REPAIR", "code_information": [{"code": "345T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION CNS", "code_information": [{"code": "61624", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1072.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1072.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1072.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1072.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1072.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION NON-CNS", "code_information": [{"code": "61626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 868.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 868.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 868.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 868.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 868.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/EPS", "code_information": [{"code": "37215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1139.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1139.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1139.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1139.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1139.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/O EPS", "code_information": [{"code": "37216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1010.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1010.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1010.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1010.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1010.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATHETER BIOPSY", "code_information": [{"code": "37200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1290.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCERV CATH FALLOPN T", "code_information": [{"code": "74742", "type": "CPT"}, {"code": "4914742", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 3809.61, "gross_charge": 18141.0, "discounted_cash": 13605.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3809.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCOCHLEAR APPROACH/SKULL", "code_information": [{"code": "61596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2488.92, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2488.92, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2488.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2488.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2488.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCONDYLAR APPROACH/SKULL", "code_information": [{"code": "61597", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2720.71, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2720.71, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2720.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2720.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2720.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCRANIAL DOPP COMP", "code_information": [{"code": "93886", "type": "CPT"}, {"code": "5063886", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 314.02, "maximum": 362.26, "gross_charge": 750.0, "discounted_cash": 562.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 362.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 323.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 314.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 362.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 362.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 362.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 362.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCRV ABLTJ UTRN FIBRD RF", "code_information": [{"code": "58580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS CARBOXYHB", "code_information": [{"code": "88740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS METHB", "code_information": [{"code": "88741", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS PACING", "code_information": [{"code": "92953", "type": "CPT"}, {"code": "6100610", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 820.02, "gross_charge": 1179.0, "discounted_cash": 884.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 738.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 717.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 820.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 820.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 820.02, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MEASUREMENTS", "code_information": [{"code": "602T", "type": "CPT"}], "standard_charges": [{"minimum": 201.33, "maximum": 201.33, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 201.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 201.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MONITORING", "code_information": [{"code": "603T", "type": "CPT"}], "standard_charges": [{"minimum": 508.04, "maximum": 508.04, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 508.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 508.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSECT ARTERY SINUS", "code_information": [{"code": "61611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 436.69, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 436.69, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 436.69, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 436.69, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 436.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSECT PULMONARY ARTERY", "code_information": [{"code": "33922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1402.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1402.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1402.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1402.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1402.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSESOPH DOPPL CARDIAC MON", "code_information": [{"code": "G9157", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.9, "maximum": 216.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 194.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 188.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 216.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 216.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 216.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSESOPHAGEAL ECHO", "code_information": [{"code": "93312", "type": "CPT"}, {"code": "4611115", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 361.45, "maximum": 774.86, "gross_charge": 5446.0, "discounted_cash": 4084.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 697.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 677.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSESOPHAGEAL ECHO", "code_information": [{"code": "93312", "type": "CPT"}, {"code": "4623312", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 361.45, "maximum": 774.86, "gross_charge": 5961.0, "discounted_cash": 4470.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 697.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 677.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSESOPHAGEAL ECHO", "code_information": [{"code": "93312", "type": "CPT"}, {"code": "4633400", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 361.45, "maximum": 774.86, "gross_charge": 5961.0, "discounted_cash": 4470.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 697.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 677.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 774.86, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 361.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ABDOMINAL MUSCLE", "code_information": [{"code": "27100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58974", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58976", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF SPINAL MUSCLE", "code_information": [{"code": "27105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER SKIN PEDICLE FLAP", "code_information": [{"code": "15650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 903.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER TENDON TO PELVIS", "code_information": [{"code": "27098", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFERRIN", "code_information": [{"code": "84466", "type": "CPT"}, {"code": "4104462", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.12, "gross_charge": 426.0, "discounted_cash": 319.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFERRIN", "code_information": [{"code": "84466", "type": "CPT"}, {"code": "7254462", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.12, "gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.12, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFUSION BLD/BLD COMP", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "4546430", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 2920.0, "discounted_cash": 2190.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 613.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 2774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 2774.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1077.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 2190.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 2190.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFUSION BLD/BLD COMP", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "6103110", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 1537.0, "discounted_cash": 1152.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 322.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 1460.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 1460.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 567.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 1152.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 1152.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFUSION BLD/BLD COMP", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "6293110", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 1537.0, "discounted_cash": 1152.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 322.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 1460.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 1460.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 567.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 1152.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 1152.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFUSION BLD/BLD COMP", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "6923110", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "gross_charge": 1537.0, "discounted_cash": 1152.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 322.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "standard_charge_dollar": 1460.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "standard_charge_dollar": 1460.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 567.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "standard_charge_dollar": 1152.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 1152.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFUSN REACTN W RPT", "code_information": [{"code": "86078", "type": "CPT"}, {"code": "4106648", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 174.29, "gross_charge": 601.0, "discounted_cash": 450.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC", "code_information": [{"code": "69", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26521.76, "maximum": 33420.99, "estimated_discounted_cash": 69567.98, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26521.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33420.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSLUMBAR RENAL CYST", "code_information": [{"code": "74470", "type": "CPT"}, {"code": "4914470", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1736.7, "gross_charge": 8270.0, "discounted_cash": 6202.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1736.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSORL LWR ESOPHGL MYOTOMY", "code_information": [{"code": "43497", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPERI NEEDLE PLACE PROS", "code_information": [{"code": "55875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1612.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPETROSAL APPROACH/SKULL", "code_information": [{"code": "61598", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPL ALLOGRAFT PANCREAS", "code_information": [{"code": "48554", "type": "CPT"}], "standard_charges": [{"minimum": 2282.86, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2282.86, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2282.86, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2282.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2282.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2282.86, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FEMUR RIDGE", "code_information": [{"code": "27140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 893.94, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 893.94, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 893.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 893.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 893.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FOREARM TENDON", "code_information": [{"code": "25310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FOREARM TENDON", "code_information": [{"code": "25312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT HAND TENDON", "code_information": [{"code": "26480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT OF THIGH TENDON", "code_information": [{"code": "27396", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1304.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT PALM TENDON", "code_information": [{"code": "26485", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT RELATED PER DIEM", "code_information": [{"code": "S9975", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT URETER TO SKIN", "code_information": [{"code": "50860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 981.25, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 981.25, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 981.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 981.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 981.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT HAND TENDON", "code_information": [{"code": "26483", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT PALM TENDON", "code_information": [{"code": "26489", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION HEART/LUNG", "code_information": [{"code": "33935", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3568.26, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3568.26, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3568.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3568.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3568.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF HEART", "code_information": [{"code": "33945", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4421.24, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4421.24, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4421.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4421.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4421.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2281.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2281.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2281.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2281.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2281.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2558.23, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2558.23, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2558.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2558.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2558.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF LIVER", "code_information": [{"code": "47135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4506.6, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4506.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4506.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4506.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4506.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF MULTIVISC", "code_information": [{"code": "S2054", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF SMALL INT", "code_information": [{"code": "S2053", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTS OF THIGH TENDONS", "code_information": [{"code": "27397", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1920.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLJ HEMATOPOIETIC BOOST", "code_information": [{"code": "38243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLT ALLO HCT/DONOR", "code_information": [{"code": "38240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1367.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLT ALLO LYMPHOCYTES", "code_information": [{"code": "38242", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 516.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLT AUTOL HCT/DONOR", "code_information": [{"code": "38241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 514.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORT X-RAY MULTIPL", "code_information": [{"code": "R0075", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORTABLE EKG", "code_information": [{"code": "R0076", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORTABLE X-RAY", "code_information": [{"code": "R0070", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPORTATION COSTS TO AND", "code_information": [{"code": "S9992", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION OF VEIN VALVE", "code_information": [{"code": "34510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1135.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1135.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1135.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1135.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1135.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION OVARY(S)", "code_information": [{"code": "58825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 683.91, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 683.91, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 683.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 683.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 683.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSSEPTAL FIBEROTOMY", "code_information": [{"code": "D7291", "type": "HCPCS"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTEMPORAL APPROACH/SKULL", "code_information": [{"code": "61595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2266.6, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2266.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2266.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2266.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2266.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSTERASE AST(SGOT)", "code_information": [{"code": "84450", "type": "CPT"}, {"code": "4104450", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.35, "gross_charge": 136.0, "discounted_cash": 102.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTERASE AST(SGOT)", "code_information": [{"code": "84450", "type": "CPT"}, {"code": "7254450", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.35, "gross_charge": 27.0, "discounted_cash": 20.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR CATH FOR STENT", "code_information": [{"code": "33621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43334", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITH CC", "code_information": [{"code": "669", "type": "MS-DRG"}], "standard_charges": [{"minimum": 51529.5, "maximum": 64934.13, "estimated_discounted_cash": 78524.25, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 51529.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 64934.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITH MCC", "code_information": [{"code": "668", "type": "MS-DRG"}], "standard_charges": [{"minimum": 96949.84, "maximum": 122169.88, "estimated_discounted_cash": 93820.18, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 96949.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 122169.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "670", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32448.31, "maximum": 40889.25, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32448.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40889.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROSTATECTOMY WITH CC/MCC", "code_information": [{"code": "713", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49915.89, "maximum": 62900.75, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49915.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 62900.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC", "code_information": [{"code": "714", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35107.79, "maximum": 44240.56, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35107.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44240.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL RF TREATMENT", "code_information": [{"code": "53860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSVRS A-ARCH GRF HYPTHRM", "code_information": [{"code": "33871", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANYLCYPROMINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311768", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANYLCYPROMINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311768", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRASTUZUMAB-ANNS PER 10MG IJ", "code_information": [{"code": "Q5117", "type": "HCPCS"}, {"code": "5324862", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 42.8, "maximum": 47.55, "gross_charge": 834.0, "discounted_cash": 625.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 47.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 47.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 47.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 47.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRASTUZUMAB-ANNS PER 10MG IJ", "code_information": [{"code": "Q5117", "type": "HCPCS"}, {"code": "5324862", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 42.8, "maximum": 47.55, "gross_charge": 834.0, "discounted_cash": 625.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 42.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 47.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 47.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 47.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 47.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAUMA RESPONS W/HOSP CRITI", "code_information": [{"code": "G0390", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC", "code_information": [{"code": "604", "type": "MS-DRG"}], "standard_charges": [{"minimum": 48876.66, "maximum": 61591.19, "estimated_discounted_cash": 52368.4, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 48876.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61591.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC", "code_information": [{"code": "605", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30413.03, "maximum": 38324.52, "estimated_discounted_cash": 51441.26, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30413.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38324.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC INJURY WITH MCC", "code_information": [{"code": "913", "type": "MS-DRG"}], "standard_charges": [{"minimum": 54271.99, "maximum": 68390.03, "estimated_discounted_cash": 73975.2, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 54271.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 68390.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC INJURY WITHOUT MCC", "code_information": [{"code": "914", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29400.37, "maximum": 37048.43, "estimated_discounted_cash": 70448.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29400.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37048.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC", "code_information": [{"code": "86", "type": "MS-DRG"}], "standard_charges": [{"minimum": 43252.25, "maximum": 54503.67, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43252.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 54503.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [{"code": "85", "type": "MS-DRG"}], "standard_charges": [{"minimum": 75431.62, "maximum": 95054.02, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 75431.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 95054.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC", "code_information": [{"code": "87", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30369.87, "maximum": 38270.13, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30369.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38270.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC", "code_information": [{"code": "83", "type": "MS-DRG"}], "standard_charges": [{"minimum": 46343.35, "maximum": 58398.88, "estimated_discounted_cash": 56456.32, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46343.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 58398.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [{"code": "82", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6355.9, "maximum": 95627.22, "estimated_discounted_cash": 55580.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18130.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10137.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12457.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 35820.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10667.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13108.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19077.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 37691.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 13842.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 39800.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 20144.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11264.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 39800.63, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11264.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 13842.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 20144.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11264.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 13842.12, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20144.87, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 39800.63, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 33737.69, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6355.9, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8047.94, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 12205.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 75886.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 95627.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC", "code_information": [{"code": "84", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31734.47, "maximum": 39989.72, "estimated_discounted_cash": 102951.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31734.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39989.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAZODONE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311795", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAZODONE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311795", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAZODONE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311791", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAZODONE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311791", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRB AMPLIFICATION METHOD", "code_information": [{"code": "81340", "type": "CPT"}, {"code": "7251341", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1066.93, "gross_charge": 4435.0, "discounted_cash": 3326.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1066.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 208.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 208.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRB@ GENE REARRANGE DIRPROBE", "code_information": [{"code": "81341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 253.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 253.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRCATH REPLACE AORTIC VALVE", "code_information": [{"code": "33366", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15495.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15495.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3001.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27846", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27848", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE FRACTURE", "code_information": [{"code": "28445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 75.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 75.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 75.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 75.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 75.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28495", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CHEST LINING", "code_information": [{"code": "32215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 794.53, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 794.53, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 794.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 794.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 794.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21431", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 754.28, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 754.28, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 754.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 754.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 754.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21432", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 665.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 665.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 665.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 665.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 665.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21433", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1633.07, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1633.07, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1633.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1633.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1633.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1290.93, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1290.93, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1290.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1290.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1290.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21436", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1839.74, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1839.74, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1839.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1839.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1839.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT DENTAL RIDGE FRACTURE", "code_information": [{"code": "21440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT DENTAL RIDGE FRACTURE", "code_information": [{"code": "21445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT EACH ADD SPINE FX", "code_information": [{"code": "22328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 277.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 277.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 277.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 277.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 277.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 784.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 784.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 784.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 784.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 784.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 28575.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3140.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2976.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24586", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24587", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT EYELID BY INJECTION", "code_information": [{"code": "68200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2861.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26775", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 180.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 180.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 180.18, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 180.18, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 180.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2967.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12672.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14082.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26735", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26742", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26746", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26765", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7021.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT BONE LESION", "code_information": [{"code": "28005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 9276.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 930.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3140.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOREARM BONE LESION", "code_information": [{"code": "25035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6440.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25574", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [{"code": "25575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [{"code": "25600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [{"code": "25605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5080.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE ULNAR STYLOID", "code_information": [{"code": "25652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FX DISTAL RADIAL", "code_information": [{"code": "25606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FX RAD EXTRA-ARTICUL", "code_information": [{"code": "25607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FX RAD INTRA-ARTICUL", "code_information": [{"code": "25608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FX RADIAL 3+ FRAG", "code_information": [{"code": "25609", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND BONE LESION", "code_information": [{"code": "26034", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26686", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HEEL FRACTURE", "code_information": [{"code": "28415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27253", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 940.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 940.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 940.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 940.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 940.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27254", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1256.41, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1256.41, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1256.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1256.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1256.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27256", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27257", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27258", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1095.65, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1095.65, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1095.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1095.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1095.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27259", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1517.8, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1517.8, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1517.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1517.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1517.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3111.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1644.79, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1644.79, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1644.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1644.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1644.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27228", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1882.07, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1882.07, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1882.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1882.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1882.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 968.68, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 968.68, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 968.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 968.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 968.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP WALL FRACTURE", "code_information": [{"code": "27226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 987.4, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 987.4, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 987.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 987.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 987.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24538", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24566", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24577", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24579", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24582", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 949.74, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 949.74, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 949.74, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 949.74, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 949.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1124.06, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1124.06, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1124.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1124.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1124.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1229.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1229.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1229.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1229.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1229.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27532", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 917.45, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 917.45, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 917.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 917.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 917.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1171.22, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1171.22, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1171.22, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1171.22, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1171.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 838.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 838.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 838.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 838.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 838.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE(S)", "code_information": [{"code": "27538", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2967.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27566", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP FRACTURE", "code_information": [{"code": "27520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP FRACTURE", "code_information": [{"code": "27524", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 751.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 751.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 751.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 751.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 751.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 332.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21452", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21453", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21454", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21461", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21462", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1782.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1158.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1158.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1158.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1158.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1158.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG BONE LESION", "code_information": [{"code": "27607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27824", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27826", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27827", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27828", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG JOINT", "code_information": [{"code": "27829", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 14301.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28475", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28476", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28485", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 13915.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE", "code_information": [{"code": "28456", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1071.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 671.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 671.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 671.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 671.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 671.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21423", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT NECK SPINE FRACTURE", "code_information": [{"code": "22326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1406.87, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1406.87, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1406.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1406.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1406.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/GRAFT", "code_information": [{"code": "22319", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1688.58, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1688.58, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1688.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1688.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1688.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/O GRAFT", "code_information": [{"code": "22318", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1542.01, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1542.01, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1542.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1542.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1542.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC FRACTURE(S)", "code_information": [{"code": "27215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 730.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 730.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 730.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 730.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 730.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1047.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1047.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1047.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1047.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1047.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27217", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1004.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1004.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1004.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1004.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1004.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27218", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1342.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1342.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1342.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1342.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1342.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PLEURODESIS W/AGENT", "code_information": [{"code": "32560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 346.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 346.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 346.79, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 346.79, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 346.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24655", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24666", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SESAMOID BONE FRACTURE", "code_information": [{"code": "28530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SESAMOID BONE FRACTURE", "code_information": [{"code": "28531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1137.99, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1137.99, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1137.99, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1137.99, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1137.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 633.44, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 633.44, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 633.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 633.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 633.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27176", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 899.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 899.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 899.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 899.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 899.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27177", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1095.48, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1095.48, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1095.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1095.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1095.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27178", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 876.43, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 876.43, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 876.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 876.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 876.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27181", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1052.03, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1052.03, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1052.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1052.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1052.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CANAL LESION", "code_information": [{"code": "62282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CORD LESION", "code_information": [{"code": "62280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CORD LESION", "code_information": [{"code": "62281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 315.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SPINE FRACTURE", "code_information": [{"code": "22325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1344.05, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1344.05, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1344.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1344.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1344.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 565.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 565.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 565.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 565.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 565.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27202", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27232", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 759.49, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 759.49, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 759.49, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 759.49, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 759.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 904.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 904.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 904.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 904.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 904.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1164.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1164.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1164.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1164.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1164.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 938.33, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 938.33, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 938.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 938.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 938.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1147.95, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1147.95, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1147.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1147.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1147.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27245", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1403.54, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1403.54, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1403.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1403.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1403.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 753.84, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 753.84, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 753.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 753.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 753.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27517", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27519", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 961.16, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 961.16, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 961.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 961.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 961.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THORAX SPINE FRACTURE", "code_information": [{"code": "22327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1389.12, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1389.12, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1389.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1389.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1389.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB DISLOCATION", "code_information": [{"code": "26641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2881.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 62.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28636", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3140.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 47.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 47.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 47.07, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 47.07, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 47.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 659.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28666", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE FRACTURE", "code_information": [{"code": "28525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TRIGEMINAL NERVE", "code_information": [{"code": "61790", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 806.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TRIGEMINAL TRACT", "code_information": [{"code": "61791", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 647.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT UTERUS INFECTION", "code_information": [{"code": "59830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 436.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 436.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 436.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 436.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 436.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINA INFECTION", "code_information": [{"code": "57150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 30.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 30.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 30.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 30.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 30.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINAL BLEEDING", "code_information": [{"code": "57180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 60.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25624", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25628", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3140.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25676", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25695", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST FRACTURE", "code_information": [{"code": "25680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST FRACTURE", "code_information": [{"code": "25685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT/GRAFT HEEL FRACTURE", "code_information": [{"code": "28420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT MOUTH ROOF LESION", "code_information": [{"code": "42160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 147.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 147.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 147.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 147.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 147.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46942", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 85.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27786", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27788", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27792", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 21543.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5908.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27814", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10342.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27816", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27818", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6992.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 15246.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27823", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28436", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF BLADDER LESION", "code_information": [{"code": "51720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 10930.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF BONE CYST", "code_information": [{"code": "20615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF CHOROID LESION", "code_information": [{"code": "67220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 184.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 184.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 184.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 184.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 184.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF CORNEAL LESION", "code_information": [{"code": "65450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF EYELID LESIONS", "code_information": [{"code": "68040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27784", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FOOT INFECTION", "code_information": [{"code": "28002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FOOT INFECTION", "code_information": [{"code": "28003", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 950.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF GUM LESION", "code_information": [{"code": "41850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEAD INJURY", "code_information": [{"code": "62010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1422.61, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1422.61, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1422.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1422.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1422.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MISCARRIAGE", "code_information": [{"code": "59812", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "estimated_discounted_cash": 14045.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MISCARRIAGE", "code_information": [{"code": "59821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 849.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MOUTH LESION", "code_information": [{"code": "40820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 169.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 169.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 169.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 169.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 169.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 33590.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 818.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 69.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 69.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 69.87, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 69.87, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 69.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1516.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 3140.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 89.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RECTAL PROLAPSE", "code_information": [{"code": "45520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 216.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 216.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 216.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 216.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 216.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 229.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 229.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 229.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 229.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 229.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67218", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 814.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21812", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21813", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27503", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27506", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1310.2, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1310.2, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1310.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1310.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1310.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27507", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 977.95, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 977.95, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 977.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 977.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 977.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27508", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27509", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1027.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1027.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1027.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1027.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1027.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1290.35, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1290.35, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1290.35, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1290.35, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1290.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27514", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1072.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1072.75, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1072.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1072.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1072.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27752", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5908.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 79.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27756", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1169.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27758", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1837.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27759", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 9008.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13334.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2646.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TOE FRACTURE", "code_information": [{"code": "28510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 58.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 58.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 58.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 58.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 58.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TOE FRACTURE", "code_information": [{"code": "28515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 75.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 75.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 75.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 75.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 75.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1331.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 855.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT X10SV RETINOPATHY", "code_information": [{"code": "67228", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 232.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AB", "code_information": [{"code": "86780", "type": "CPT"}, {"code": "4106782", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.6, "gross_charge": 246.0, "discounted_cash": 184.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AB", "code_information": [{"code": "86780", "type": "CPT"}, {"code": "7056654", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.6, "gross_charge": 246.0, "discounted_cash": 184.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 67.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AG IF", "code_information": [{"code": "87285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPROSTINIL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3285", "type": "HCPCS"}], "standard_charges": [{"minimum": 49.24, "maximum": 54.71, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 49.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 54.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 54.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 54.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 54.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPROSTINIL, NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7686", "type": "HCPCS"}], "standard_charges": [{"minimum": 716.48, "maximum": 796.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 716.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 796.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 796.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 796.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 796.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRETINOIN 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311800", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRETINOIN 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311800", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRETINOIN TOPICAL 5 G", "code_information": [{"code": "S0117", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.23, "maximum": 4.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 311+", "code_information": [{"code": "239U", "type": "CPT"}], "standard_charges": [{"minimum": 3500.0, "maximum": 3500.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3500.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3500.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 55-74", "code_information": [{"code": "242U", "type": "CPT"}], "standard_charges": [{"minimum": 5000.0, "maximum": 5000.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5000.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5000.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 83+", "code_information": [{"code": "326U", "type": "CPT"}], "standard_charges": [{"minimum": 5000.0, "maximum": 5000.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5000.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5000.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL DNA 23", "code_information": [{"code": "171U", "type": "CPT"}], "standard_charges": [{"minimum": 1519.06, "maximum": 1519.06, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1519.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1519.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ DNA 194 GENES", "code_information": [{"code": "50U", "type": "CPT"}], "standard_charges": [{"minimum": 2916.6, "maximum": 2916.6, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2916.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2916.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ DNA 324 GENES", "code_information": [{"code": "37U", "type": "CPT"}], "standard_charges": [{"minimum": 3500.0, "maximum": 3500.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3500.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3500.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRH STIMULATION PANEL", "code_information": [{"code": "80438", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 257.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 257.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 70.41, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 70.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 70.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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"standard_charge_dollar": 8.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIHEXYPHENIDYL 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316513", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIHEXYPHENIDYL 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316513", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIHEXYPHENIDYL 2MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311942", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIHEXYPHENIDYL 2MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311942", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIHEXYPHENIDYL 5MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311946", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIHEXYPHENIDYL 5MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311946", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIHEXYPHENIDYL2MG/5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316514", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIHEXYPHENIDYL2MG/5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316514", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIIODTHYRN (T3/T4) UPTAKE", "code_information": [{"code": "84479", "type": "CPT"}, {"code": "4104250", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.0, "gross_charge": 241.0, "discounted_cash": 180.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIIODTHYRNINE TOTAL T3", "code_information": [{"code": "84480", "type": "CPT"}, {"code": "4103538", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.31, "gross_charge": 564.0, "discounted_cash": 423.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 72.31, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIIODTHYRNINE TOTAL T3", "code_information": [{"code": "84480", "type": "CPT"}, {"code": "7253539", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.31, "gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 72.31, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIM DYSTRPHIC NAILS ANY", "code_information": [{"code": "6900127", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM DYSTRPHIC NAILS ANY", "code_information": [{"code": "6900127", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM NAIL(S)", "code_information": [{"code": "G0127", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIM NAIL(S) ANY NUMBER", "code_information": [{"code": "11719", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 11.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIM NAILS ANY NUMBER", "code_information": [{"code": "6900035", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM NAILS ANY NUMBER", "code_information": [{"code": "6900035", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM SKIN LESION 2-4", "code_information": [{"code": "6900071", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM SKIN LESION 2-4", "code_information": [{"code": "6900071", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM SKIN LESION >4", "code_information": [{"code": "6900072", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM SKIN LESION >4", "code_information": [{"code": "6900072", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM SKIN LESION SINGLE", "code_information": [{"code": "6900070", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM SKIN LESION SINGLE", "code_information": [{"code": "6900070", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1299.0, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIMETHOBENZAMIDE HCL 250MG", "code_information": [{"code": "Q0173", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.76, "maximum": 0.84, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIMETHOPRIM 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312050", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIMETHOPRIM 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312050", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIPTORELIN PAMOATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3315", "type": "HCPCS"}], "standard_charges": [{"minimum": 427.36, "maximum": 474.84, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 427.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 474.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 474.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 474.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 474.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST ART", "code_information": [{"code": "37246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST VEIN", "code_information": [{"code": "37248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP ADDL ART", "code_information": [{"code": "37247", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP ADDL VEIN", "code_information": [{"code": "37249", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML DIL AQ O/F CAN W/O ST", "code_information": [{"code": "66174", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML DIL AQ O/F CAN W/ST", "code_information": [{"code": "66175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ABD AORTA", "code_information": [{"code": "236T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC BRCHIOCPH", "code_information": [{"code": "237T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ILIAC ART", "code_information": [{"code": "238T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC RENAL ART", "code_information": [{"code": "234T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC VISCERAL", "code_information": [{"code": "235T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRML DSTRJ IOS BVN 1ST 2 L/S", "code_information": [{"code": "64628", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 29811.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRML DSTRJ IOS BVN EA ADDL", "code_information": [{"code": "64629", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSCTH BIOPSY", "code_information": [{"code": "4918005", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 14724.0, "discounted_cash": 11043.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRNSCTH BIOPSY S&I", "code_information": [{"code": "75970", "type": "CPT"}, {"code": "4915971", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 590.94, "gross_charge": 2814.0, "discounted_cash": 2110.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 590.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSCTH EMBOLIZATN", "code_information": [{"code": "75894", "type": "CPT"}, {"code": "4915895", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2123.52, "gross_charge": 10112.0, "discounted_cash": 7584.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2123.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV BIL", "code_information": [{"code": "339T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV UNL", "code_information": [{"code": "338T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSPER PLC NDL/CATH PROSTATE", "code_information": [{"code": "5105859", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 730.0, "discounted_cash": 547.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRNSPLJ DON-DRV CLL-FR DNA", "code_information": [{"code": "118U", "type": "CPT"}], "standard_charges": [{"minimum": 2753.25, "maximum": 2753.25, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2753.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2753.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ KDN ALGRFT REJ 1494", "code_information": [{"code": "88U", "type": "CPT"}], "standard_charges": [{"minimum": 3159.42, "maximum": 3159.42, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3159.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3159.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ PD LVR&BWL CD154+CLL", "code_information": [{"code": "81560", "type": "CPT"}], "standard_charges": [{"minimum": 640.73, "maximum": 640.73, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 640.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 640.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ RNL MEAS CD154+CLL", "code_information": [{"code": "18M", "type": "CPT"}], "standard_charges": [{"minimum": 640.73, "maximum": 640.73, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 640.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 640.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSVN INTRHEP PORT SHNT", "code_information": [{"code": "4917182", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 33217.0, "discounted_cash": 24912.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRNSXJ/REPOS ABRRNT RNL VSLS", "code_information": [{"code": "50100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 981.82, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 981.82, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 981.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 981.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 981.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TROPONIN QUAN", "code_information": [{"code": "84484", "type": "CPT"}, {"code": "4104484", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.19, "gross_charge": 324.0, "discounted_cash": 243.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 50.19, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TROPONIN QUAN/2", "code_information": [{"code": "84484", "type": "CPT"}, {"code": "4107235", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.19, "gross_charge": 161.0, "discounted_cash": 120.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 50.19, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRTMNT SIMULATION 3D IMAGE", "code_information": [{"code": "D0393", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRURL ABLTJ MAL PRST8 TISS", "code_information": [{"code": "582T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRURL DSTRJ PRST8 TISS RF WV", "code_information": [{"code": "53854", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRY CATH ACE IV BASIC 18G", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8083291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 76.86, "maximum": 76.86, "gross_charge": 366.0, "discounted_cash": 274.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 76.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRY CATH CV DL INTERMED", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8178764", "type": "CDM"}], "standard_charges": [{"minimum": 311.85, "maximum": 311.85, "gross_charge": 1485.0, "discounted_cash": 1113.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 311.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRY CATH PICC NRS SL FUL", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8057028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 248.43, "maximum": 248.43, "gross_charge": 1183.0, "discounted_cash": 887.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 248.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRY CATH PICC SGL MAXBAR", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8057021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.66, "maximum": 324.66, "gross_charge": 1546.0, "discounted_cash": 1159.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 324.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRY CATH POLY MDLN MAXBR", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8177673", "type": "CDM"}], "standard_charges": [{"minimum": 303.03, "maximum": 303.03, "gross_charge": 1443.0, "discounted_cash": 1082.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 303.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRY GROSHONG", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8083580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 254.52, "maximum": 254.52, "gross_charge": 1212.0, "discounted_cash": 909.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 254.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRY INTRD PERC SHLY TRCH", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8083682", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 538.23, "maximum": 538.23, "gross_charge": 2563.0, "discounted_cash": 1922.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 538.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRY PICC", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8084018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 30.66, "maximum": 30.66, "gross_charge": 146.0, "discounted_cash": 109.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 30.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRYPSIN FECES QUAL", "code_information": [{"code": "84488", "type": "CPT"}, {"code": "7254488", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.23, "gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 37.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRYPTASE LEVEL", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "7253529", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.03, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TSH", "code_information": [{"code": "84443", "type": "CPT"}, {"code": "4104443", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.67, "gross_charge": 443.0, "discounted_cash": 332.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 85.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 23.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O CONTR, CONT ECG", "code_information": [{"code": "C8930", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.15, "maximum": 1077.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 969.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 942.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1077.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1077.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1077.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CONT, F/U", "code_information": [{"code": "C8922", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.15, "maximum": 1077.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 969.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 942.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1077.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1077.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1077.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W/O DOPPLER COMPLETE", "code_information": [{"code": "93307", "type": "CPT"}], "standard_charges": [{"minimum": 221.94, "maximum": 359.1, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 221.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 323.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 314.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 359.1, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 221.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 221.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 221.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 221.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTVI/RPLCMT W/PRSTC VLV PERQ", "code_information": [{"code": "646T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ APPR 1ST PROSTH", "code_information": [{"code": "569T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ EA ADDL PROSTH", "code_information": [{"code": "570T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21668.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19500.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21668.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TUBERCULIN PPD 5TU IJ", "code_information": [{"code": "86580", "type": "CPT"}, {"code": "5324989", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.57, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 34.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMOR CELL DEPLETE OF HARVST", "code_information": [{"code": "38211", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 78.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 78.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 78.54, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 78.54, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 78.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TUMOR IMM PER SPEC COMPT", "code_information": [{"code": "88361", "type": "CPT"}, {"code": "4308361", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 356.9, "gross_charge": 483.0, "discounted_cash": 362.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 356.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 179.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 179.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 179.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 179.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 179.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMOR IMM PER SPEC COMPT", "code_information": [{"code": "88361", "type": "CPT"}, {"code": "7270090", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 356.9, "gross_charge": 483.0, "discounted_cash": 362.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 356.9, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 179.33, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 179.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 203.34, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMOR LOC 2D WHOLE BDY 2+DAYS", "code_information": [{"code": "78804", "type": "CPT"}, {"code": "5208804", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1305.94, "gross_charge": 5842.0, "discounted_cash": 4381.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1226.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1205.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 651.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 651.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 651.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 651.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 651.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMOR LOCAL 2+ AREA 1+DAYS", "code_information": [{"code": "78801", "type": "CPT"}, {"code": "5202012", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 815.85, "gross_charge": 3885.0, "discounted_cash": 2913.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 815.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 598.35, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 277.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 277.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 277.63, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 277.63, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 277.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMOR LOCAL PLANAR SNGL AREA", "code_information": [{"code": "78800", "type": "CPT"}, {"code": "5202002", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 714.84, "gross_charge": 3404.0, "discounted_cash": 2553.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 714.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 464.13, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 212.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 212.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 212.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 212.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 212.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMOR LOCAL PLANAR WHOLEBDY", "code_information": [{"code": "78802", "type": "CPT"}, {"code": "5202022", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 2565.57, "gross_charge": 12217.0, "discounted_cash": 9162.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2565.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 791.52, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 360.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 360.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 360.83, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 360.83, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 360.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMR LOC SPECT SGL AREA SGL DY", "code_information": [{"code": "78803", "type": "CPT"}, {"code": "5208803", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1305.94, "gross_charge": 6168.0, "discounted_cash": 4626.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1295.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 812.87, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 405.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 405.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 405.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 405.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 405.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TWIST DRILL HOLE", "code_information": [{"code": "61105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 427.38, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 427.38, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 427.38, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 427.38, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 427.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TWN ZYG GEN SEQ ALYS CHRMS2", "code_information": [{"code": "60U", "type": "CPT"}], "standard_charges": [{"minimum": 759.05, "maximum": 759.05, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 759.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 759.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TWO-WAY AUDIO AND VIDEO HHS", "code_information": [{"code": "G0320", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 1 CC/<", "code_information": [{"code": "11950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 1.1-5.0CC", "code_information": [{"code": "11951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 43.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 5.1-10CC", "code_information": [{"code": "11952", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS >10.0 CC", "code_information": [{"code": "11954", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX DVC DESIGN CMPLX", "code_information": [{"code": "77334", "type": "CPT"}, {"code": "5107334", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 557.55, "gross_charge": 2542.0, "discounted_cash": 1906.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 533.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 400.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 195.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 501.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 557.55, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 195.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 195.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 195.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 195.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX DVC DESIGN INT", "code_information": [{"code": "77333", "type": "CPT"}, {"code": "5107333", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 347.34, "gross_charge": 1654.0, "discounted_cash": 1240.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 347.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 199.46, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 94.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 193.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 94.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 94.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 94.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 94.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX DVC DESIGN SMPL", "code_information": [{"code": "77332", "type": "CPT"}, {"code": "5107332", "type": "CDM"}, {"code": "333", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 315.42, "gross_charge": 1502.0, "discounted_cash": 1126.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 315.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 178.11, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 91.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 193.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 214.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 91.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 91.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 91.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 91.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX GASTRO INTUB W/ASP", "code_information": [{"code": "43753", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX I131 SOD CAP PER MCI", "code_information": [{"code": "A9517", "type": "HCPCS"}, {"code": "5199517", "type": "CDM"}, {"code": "344", "type": "RC"}], "standard_charges": [{"minimum": 55.07, "maximum": 61.17, "gross_charge": 167.0, "discounted_cash": 125.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 55.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX PSYCH FAM 30", "code_information": [{"code": "90847", "type": "CPT"}, {"code": "6424210", "type": "CDM"}, {"code": "913", "type": "RC"}], "standard_charges": [{"minimum": 88.52, "maximum": 198.66, "gross_charge": 604.0, "discounted_cash": 453.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER 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"plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 88.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 88.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 88.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX PSYCH FAM 50", "code_information": [{"code": "90847", "type": "CPT"}, {"code": "6424214", "type": "CDM"}, {"code": "913", "type": "RC"}], "standard_charges": [{"minimum": 88.52, "maximum": 198.66, "gross_charge": 604.0, "discounted_cash": 453.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 88.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 178.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 173.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 88.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 88.52, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 88.52, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 88.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX PSYCH MLTFAM 60", "code_information": [{"code": "90849", "type": "CPT"}, {"code": "6400849", "type": "CDM"}, {"code": "916", "type": "RC"}], "standard_charges": [{"minimum": 27.1, "maximum": 198.66, "gross_charge": 585.0, "discounted_cash": 438.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 178.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 173.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX PSYCH MLTFAM 60", "code_information": [{"code": "90849", "type": "CPT"}, {"code": "6420625", "type": "CDM"}, {"code": "913", "type": "RC"}], "standard_charges": [{"minimum": 27.1, "maximum": 198.66, "gross_charge": 585.0, "discounted_cash": 438.75, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 178.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 173.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 198.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.1, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.1, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX SUPFC WND DEHSN SMPL CLSR", "code_information": [{"code": "12020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 6635.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX SUPFC WND DEHSN W/PACKING", "code_information": [{"code": "12021", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TYMPANOMETRY", "code_information": [{"code": "92567", "type": "CPT"}], "standard_charges": [{"minimum": 43.75, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE 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NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UMBILICAL ART LINE NB", "code_information": [{"code": "3112120", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UMBILICAL ART LINE NB", "code_information": [{"code": "3112120", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UMBILICAL CORD OCCLUD W/US", "code_information": [{"code": "59072", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 123.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UMBILICAL VEIN LINE NB", "code_information": [{"code": "3112130", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UMBILICAL VEIN LINE NB", "code_information": [{"code": "3112130", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UMECLIDINIUM BROM 7DS IH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5332808", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 176.25, "setting": "both", "billing_class": "facility"}]}, {"description": "UMECLIDINIUM BROM 7DS IH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5332808", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 176.25, "setting": "both", "billing_class": "facility"}]}, {"description": "UNCLASSIFIED DRUGS OR BIOLOG", "code_information": [{"code": "C9399", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "383", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5104.81, "maximum": 57767.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11096.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 30159.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8096.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 16509.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 8519.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 17372.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 31734.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11676.47, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 18344.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12329.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 8995.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 33510.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 33510.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 18344.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12329.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 8995.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 8995.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12329.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 18344.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 33510.7, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9823.47, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6765.54, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5104.81, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 20955.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 45842.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 57767.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [{"code": "384", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4713.44, "maximum": 35763.98, "estimated_discounted_cash": 42470.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 31700.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18912.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10356.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 12980.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 10897.77, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 13658.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 33356.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19900.36, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 14423.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11507.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 21014.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 35223.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 14423.06, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11507.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 21014.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 35223.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 35223.61, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11507.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 21014.14, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 14423.06, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 24258.63, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4713.44, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6255.45, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10337.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28381.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35763.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNGROUPABLE", "code_information": [{"code": "999", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13045.78, "maximum": 13045.78, "setting": "inpatient", "payers_information": [{"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13045.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNL THER/PROP/DIAG INJ/INF", "code_information": [{"code": "96379", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTD PX HEMIC/LYMPHTC SYS", "code_information": [{"code": "38999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTD PX SKN MUC MEMB SUBQ", "code_information": [{"code": "17999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CRANFCL&MAXLFCL PX", "code_information": [{"code": "21299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CV PX DX NUC MED", "code_information": [{"code": "78499", "type": "CPT"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOGENETIC STUDY", "code_information": [{"code": "88299", "type": "CPT"}], "standard_charges": [{"minimum": 49.76, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOPATHOLOGY PX", "code_information": [{"code": "88199", "type": "CPT"}], "standard_charges": [{"minimum": 49.76, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED DX GI PROCEDURE", "code_information": [{"code": "91299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED DX RADIOGRAPHIC PX", "code_information": [{"code": "76499", "type": "CPT"}], "standard_charges": [{"minimum": 80.9, "maximum": 80.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED E&M SERVICE", "code_information": [{"code": "99499", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED ENDOCRINE PX DX NUC", "code_information": [{"code": "78099", "type": "CPT"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED FETAL INVAS PX W/US", "code_information": [{"code": "59897", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED FLUOROSCOPIC PX", "code_information": [{"code": "76496", "type": "CPT"}], "standard_charges": [{"minimum": 80.9, "maximum": 80.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED GI PX DX NUC MED", "code_information": [{"code": "78299", "type": "CPT"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED GU PX DX NUC MED", "code_information": [{"code": "78799", "type": "CPT"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HEMATOLOGY&COAGJ PX", "code_information": [{"code": "85999", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HYSTSC PX UTERUS", "code_information": [{"code": "58579", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED IN VIVO LAB SERVICE", "code_information": [{"code": "88749", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX APPENDIX", "code_information": [{"code": "44979", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX BILIARY TRC", "code_information": [{"code": "47579", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX BLADDER", "code_information": [{"code": "51999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX ENDOC SYS", "code_information": [{"code": "60659", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX ESOPH", "code_information": [{"code": "43289", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NAP", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA SIGNATURE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX INTESTINE", "code_information": [{"code": "44238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX LIVER", "code_information": [{"code": "47379", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 15476.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX LYMPHTC SYS", "code_information": [{"code": "38589", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX OVIDCT OVRY", "code_information": [{"code": "58679", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX RENAL", "code_information": [{"code": "50549", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX SPLEEN", "code_information": [{"code": "38129", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX STOMACH", "code_information": [{"code": "43659", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX TESTIS", "code_information": [{"code": "54699", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX URETER", "code_information": [{"code": "50949", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX UTERUS", "code_information": [{"code": "58578", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAAA", "code_information": [{"code": "81599", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAXLFCL PROSTH PX", "code_information": [{"code": "21089", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MICROBIOLOGY PX", "code_information": [{"code": "87999", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PATH TEST", "code_information": [{"code": "89240", "type": "CPT"}], "standard_charges": [{"minimum": 49.76, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PX DX NUC MED", "code_information": [{"code": "78999", "type": "CPT"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MOLEC PROC", "code_information": [{"code": "81479", "type": "CPT"}, {"code": "7270054", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "gross_charge": 732.0, "discounted_cash": 549.0, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MUSCSKEL PX DX NUC", "code_information": [{"code": "78399", "type": "CPT"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MUSCSKEL PX HEAD", "code_information": [{"code": "21499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED NECROPSY (AUTOPSY)", "code_information": [{"code": "88099", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED NRVS SYS PX DX NUC", "code_information": [{"code": "78699", "type": "CPT"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED ORL SERVICE/PX", "code_information": [{"code": "92700", "type": "CPT"}], "standard_charges": [{"minimum": 7835.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ANUS", "code_information": [{"code": "46999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE BREAST", "code_information": [{"code": "19499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 2495.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE COLON", "code_information": [{"code": "45399", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12258.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ESOPHAGUS", "code_information": [{"code": "43499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE EYELIDS", "code_information": [{"code": "67999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LARYNX", "code_information": [{"code": "31599", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIPS", "code_information": [{"code": "40799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIVER", "code_information": [{"code": "47399", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE NOSE", "code_information": [{"code": "30999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ORBIT", "code_information": [{"code": "67599", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE PANCREAS", "code_information": [{"code": "48999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE RECTUM", "code_information": [{"code": "45999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE SHOULDER", "code_information": [{"code": "23929", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE SPINE", "code_information": [{"code": "22899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE STOMACH", "code_information": [{"code": "43999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ABD PERTM&OMN", "code_information": [{"code": "49999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ABDOMEN MUSCSKEL", "code_information": [{"code": "22999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ACCESSORY SINUS", "code_information": [{"code": "31299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ANT SEGMENT EYE", "code_information": [{"code": "66999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ARTHROSCOPY", "code_information": [{"code": "29999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX BILIARY TRACT", "code_information": [{"code": "47999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CARDIAC SURGERY", "code_information": [{"code": "33999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CASTING/STRPG", "code_information": [{"code": "29799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CLIN BRACHYTX", "code_information": [{"code": "77799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CONJUNCTIVA", "code_information": [{"code": "68399", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX DENTALVLR STRUX", "code_information": [{"code": "41899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX DIAPHRAGM", "code_information": [{"code": "39599", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NAP", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA SIGNATURE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ENDOCRINE SYSTEM", "code_information": [{"code": "60699", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXC PRESSURE ULC", "code_information": [{"code": "15999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXTERNAL EAR", "code_information": [{"code": "69399", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 33590.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXTRAOCULAR MUSC", "code_information": [{"code": "67399", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FEMUR/KNEE", "code_information": [{"code": "27599", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FML GENITAL SYS", "code_information": [{"code": "58999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FOOT/TOES", "code_information": [{"code": "28899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FOREARM/WRIST", "code_information": [{"code": "25999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX HANDS/FINGERS", "code_information": [{"code": "26989", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX HUMERUS/ELBOW", "code_information": [{"code": "24999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX INNER EAR", "code_information": [{"code": "69949", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LACRIMAL SYSTEM", "code_information": [{"code": "68899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LEG/ANKLE", "code_information": [{"code": "27899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LUNGS & PLEURA", "code_information": [{"code": "32999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MALE GENITAL SYS", "code_information": [{"code": "55899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MAT CARE&DLVR", "code_information": [{"code": "59899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MECKEL'S DVRTCLM", "code_information": [{"code": "44899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MED RADJ PHYSICS", "code_information": [{"code": "77399", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MEDIASTINUM", "code_information": [{"code": "39499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MIDDLE EAR", "code_information": [{"code": "69799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MUSCSKEL GENERAL", "code_information": [{"code": "20999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX NECK/THORAX", "code_information": [{"code": "21899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX NERVOUS SYSTEM", "code_information": [{"code": "64999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PALATE UVULA", "code_information": [{"code": "42299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PELVIS/HIP JOINT", "code_information": [{"code": "27299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 31438.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PHRNX ADND/TNSL", "code_information": [{"code": "42999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX POSTERIOR SEGMNT", "code_information": [{"code": "67299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX SALIVRY GLND/DUX", "code_information": [{"code": "42699", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX SMALL INTESTINE", "code_information": [{"code": "44799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 13167.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TEMPORAL BONE", "code_information": [{"code": "69979", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX MGMT", "code_information": [{"code": "77499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX PLNG", "code_information": [{"code": "77299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TONGUE FLR MOUTH", "code_information": [{"code": "41599", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TRACHEA BRONCHI", "code_information": [{"code": "31899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX URINARY SYSTEM", "code_information": [{"code": "53899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR NJX", "code_information": [{"code": "36299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR SURGERY", "code_information": [{"code": "37799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VESTIBULE MOUTH", "code_information": [{"code": "40899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED REPROD MED LAB PROC", "code_information": [{"code": "89398", "type": "CPT"}], "standard_charges": [{"minimum": 49.76, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 28.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED RESP PX DX NUC MED", "code_information": [{"code": "78599", "type": "CPT"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED SURGICAL PATH PX", "code_information": [{"code": "88399", "type": "CPT"}], "standard_charges": [{"minimum": 49.76, "maximum": 49.76, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED TRANSFUSION MED PX", "code_information": [{"code": "86999", "type": "CPT"}], "standard_charges": [{"minimum": 24.67, "maximum": 24.67, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED URINALYSIS PX", "code_information": [{"code": "81099", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED VASC ENDOSCOPY PX", "code_information": [{"code": "37501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLSTD HEMATOP RET/ENDO LYMP", "code_information": [{"code": "78199", "type": "CPT"}], "standard_charges": [{"minimum": 377.12, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX ABD PERTM&OMN", "code_information": [{"code": "49329", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX HRNAP HRNRPHY", "code_information": [{"code": "49659", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "estimated_discounted_cash": 56029.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NAP", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA SIGNATURE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX MAT CARE&DLVR", "code_information": [{"code": "59898", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX SPRMATIC CORD", "code_information": [{"code": "55559", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16629.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3751.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14965.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16629.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNPL RET OR W/COMPL W/IN 30D", "code_information": [{"code": "G9308", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNPLND HOSP READM IN 30D", "code_information": [{"code": "G9310", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSCHED DIAL ESRD PT", "code_information": [{"code": "G0257", "type": "HCPCS"}, {"code": "5600257", "type": "CDM"}, {"code": "809", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 952.79, "gross_charge": 1800.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 857.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 833.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNSCHED DIAL ESRD PT", "code_information": [{"code": "G0257", "type": "HCPCS"}, {"code": "5600257", "type": "CDM"}, {"code": "829", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 952.79, "gross_charge": 1800.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 857.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 833.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 952.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNSKILLED RESPITE CARE /15M", "code_information": [{"code": "S5150", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSKILLED RESPITECARE /DIEM", "code_information": [{"code": "S5151", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSPECIFIED ORAL ANTI-EMETIC", "code_information": [{"code": "Q0181", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNXPL CNST HRTBL DO GN XPRSN", "code_information": [{"code": "266U", "type": "CPT"}], "standard_charges": [{"minimum": 3200.0, "maximum": 3200.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3200.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPGRADE OF PACEMAKER SYSTEM", "code_information": [{"code": "33214", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61214.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15387.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8772.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55091.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61214.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8772.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8772.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8772.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8772.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPGRADE TO DUAL CHAMBER", "code_information": [{"code": "4613214", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 75425.0, "discounted_cash": 56568.75, "setting": "both", "billing_class": "facility"}]}, {"description": "UPPER EXTREMITY INFANT", "code_information": [{"code": "73092", "type": "CPT"}, {"code": "4903092", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 132.93, "gross_charge": 633.0, "discounted_cash": 474.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 132.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER EXTREMITY INFANT", "code_information": [{"code": "73092", "type": "CPT"}, {"code": "5013092", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 132.93, "gross_charge": 633.0, "discounted_cash": 474.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 132.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER GI DOUBLE CM STDY", "code_information": [{"code": "74246", "type": "CPT"}, {"code": "4904244", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 463.26, "gross_charge": 2206.0, "discounted_cash": 1654.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 463.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 243.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 135.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 135.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 135.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 135.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 135.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER GI SM INT F-THRU STD", "code_information": [{"code": "74248", "type": "CPT"}, {"code": "4904248", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.54, "gross_charge": 274.0, "discounted_cash": 205.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 57.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER GI W/SNGL CM STDY", "code_information": [{"code": "74240", "type": "CPT"}, {"code": "4904242", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 235.41, "gross_charge": 1121.0, "discounted_cash": 840.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 235.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 208.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 118.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 118.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 118.91, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 118.91, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 118.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [{"code": "256", "type": "MS-DRG"}], "standard_charges": [{"minimum": 56373.68, "maximum": 71038.44, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 56373.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 71038.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC", "code_information": [{"code": "255", "type": "MS-DRG"}], "standard_charges": [{"minimum": 89559.07, "maximum": 112856.52, "estimated_discounted_cash": 220520.4, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 89559.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 112856.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "257", "type": "MS-DRG"}], "standard_charges": [{"minimum": 36263.22, "maximum": 45696.56, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 36263.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45696.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPPR GI SCOPE W/SUBMUC INJ", "code_information": [{"code": "43236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 7617.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 379.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPRIGHT GAIT TRAINER", "code_information": [{"code": "E8001", "type": "HCPCS"}], "standard_charges": [{"minimum": 1966.98, "maximum": 2249.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2024.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1966.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2249.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2249.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2249.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UR ALBUMIN SEMIQUANTITATIVE", "code_information": [{"code": "82044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 23.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 23.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3350", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.0, "maximum": 84.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 76.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 84.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 84.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 84.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 84.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA NITROGEN SEMI-QUANT", "code_information": [{"code": "84525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 19.16, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA NITROGEN URINE", "code_information": [{"code": "84540", "type": "CPT"}, {"code": "4104540", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.24, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA NITROGEN URINE/2", "code_information": [{"code": "84540", "type": "CPT"}, {"code": "4104541", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.24, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA-N CLEARANCE TEST", "code_information": [{"code": "84545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 33.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY", "code_information": [{"code": "50970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & BIOPSY", "code_information": [{"code": "50955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & BIOPSY", "code_information": [{"code": "50974", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & CATHETER", "code_information": [{"code": "50972", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 266.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50957", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50961", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50976", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50980", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1107.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETERAL EMBOLIZATION/OCCL", "code_information": [{"code": "50705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETERAL EMBOLIZE W/IMG+S&I", "code_information": [{"code": "4910705", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10552.0, "discounted_cash": 7914.0, "setting": "both", "billing_class": "facility"}]}, {"description": "URETERAL REFLUX STUDY", "code_information": [{"code": "78740", "type": "CPT"}, {"code": "5208740", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 377.12, "gross_charge": 1749.0, "discounted_cash": 1311.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 367.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 371.32, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 207.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 207.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 207.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 207.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 207.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETEROSCOPE", "code_information": [{"code": "C1747", "type": "HCPCS"}, {"code": "8098891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4524.0, "discounted_cash": 3393.0, "setting": "both", "billing_class": "facility"}]}, {"description": "URETHRAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "671", "type": "MS-DRG"}], "standard_charges": [{"minimum": 59597.59, "maximum": 75101.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 59597.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 75101.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "672", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35841.56, "maximum": 45165.2, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35841.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45165.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHRAL STRICTURE", "code_information": [{"code": "697", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35785.12, "maximum": 45094.07, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35785.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45094.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHRLYS TRANSVAG W/ SCOPE", "code_information": [{"code": "53500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 779.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 779.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 779.85, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 779.85, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 779.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHROCYSTOGRAPHY RETR", "code_information": [{"code": "74450", "type": "CPT"}, {"code": "4904450", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 635.67, "gross_charge": 3027.0, "discounted_cash": 2270.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 635.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROCYSTOGRAPHY VOID", "code_information": [{"code": "74455", "type": "CPT"}, {"code": "4904455", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 296.52, "gross_charge": 1412.0, "discounted_cash": 1059.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 296.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 223.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 104.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 104.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 104.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 104.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 104.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URGENT CARE CENTER GLOBAL", "code_information": [{"code": "S9083", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URI EP COMPETE DIAG", "code_information": [{"code": "G8709", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URIC ACID BLOOD", "code_information": [{"code": "84550", "type": "CPT"}, {"code": "4104550", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 23.03, "gross_charge": 136.0, "discounted_cash": 102.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK 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"standard_charge_dollar": 5.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URIC ACID OTHR SOURCE", "code_information": [{"code": "84560", "type": "CPT"}, {"code": "4164557", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.24, "gross_charge": 113.0, "discounted_cash": 84.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL 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"standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URIC ACID OTHR SOURCE/2", "code_information": [{"code": "84560", "type": "CPT"}, {"code": "7254559", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.24, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS 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"code_information": [{"code": "84560", "type": "CPT"}, {"code": "4104560", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.24, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK 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"PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS MICRO ONLY", "code_information": [{"code": "81015", "type": "CPT"}, {"code": "4101015", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.48, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINALYSIS NONAUTO W/SCOPE", "code_information": [{"code": "81000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 16.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY BLADDER RETENTION", "code_information": [{"code": "78730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 124.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 124.19, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 90.05, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 90.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 90.05, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 90.05, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 90.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY REFLEX STUDY", "code_information": [{"code": "51792", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINARY STONES WITH MCC", "code_information": [{"code": "693", "type": "MS-DRG"}], "standard_charges": [{"minimum": 44640.09, "maximum": 56252.54, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44640.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 56252.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINARY STONES WITHOUT MCC", "code_information": [{"code": "694", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6653.35, "maximum": 40454.19, "estimated_discounted_cash": 28325.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 36408.39, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 21076.92, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11460.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14341.53, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 38310.07, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 22177.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15090.62, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12058.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 15935.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 40454.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12733.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 23419.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 40454.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23419.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 15935.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12733.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12733.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23419.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 40454.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 15935.2, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 8931.14, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 6653.35, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 25315.34, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 13973.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25954.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32705.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINE FLOW MEASUREMENT", "code_information": [{"code": "51736", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINE PREG TEST QUAL", "code_information": [{"code": "81025", "type": "CPT"}, {"code": "4101026", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.27, "gross_charge": 347.0, "discounted_cash": 260.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 32.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE PREG TEST QUAL", "code_information": [{"code": "81025", "type": "CPT"}, {"code": "6701025", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.27, "gross_charge": 347.0, "discounted_cash": 260.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 32.27, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE REAGENT STRIPS/TABLETS", "code_information": [{"code": "A4250", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINE SCREEN FOR BACTERIA", "code_information": [{"code": "81007", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE SHUNT TO INTESTINE", "code_information": [{"code": "50815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1257.34, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1257.34, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1257.34, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1257.34, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1257.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINE SPECIMEN COLLECT MULT", "code_information": [{"code": "P9615", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROFOLLITROPIN, 75 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3355", "type": "HCPCS"}], "standard_charges": [{"minimum": 57.09, "maximum": 63.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 57.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 63.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 63.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 63.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 63.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROG/PYELOGRAPHY RETRO", "code_information": [{"code": "74420", "type": "CPT"}, {"code": "4904420", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 675.57, "gross_charge": 3217.0, "discounted_cash": 2412.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 675.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY EXCRETORY(IVP)", "code_information": [{"code": "74400", "type": "CPT"}, {"code": "4904400", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 732.48, "gross_charge": 3488.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 732.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 244.61, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY NFS DRIP&/BLS W/NF", "code_information": [{"code": "74415", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 307.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 307.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 148.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 148.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 148.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 148.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 148.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY NFS DRIP&/BOLUS", "code_information": [{"code": "74410", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 273.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 273.47, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 131.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROKINASE 250,000 IU INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3365", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.96, "maximum": 457.73, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH 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CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URSODIOL 300MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312255", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "URSODIOL 300MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312255", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "US ABD LTD SNGLE/QUAD/FU", "code_information": [{"code": "76705", "type": "CPT"}, {"code": "4916705", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 208.23, "gross_charge": 957.0, "discounted_cash": 717.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 200.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 208.23, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ABD LTD SNGLE/QUAD/FU", "code_information": [{"code": "76705", "type": "CPT"}, {"code": "5066705", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 208.23, "gross_charge": 957.0, "discounted_cash": 717.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 200.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 208.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ABDOMEN COMPLETE", "code_information": [{"code": "76700", "type": "CPT"}, {"code": "5016690", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 403.62, "gross_charge": 1922.0, "discounted_cash": 1441.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 403.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 280.99, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 153.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 153.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 153.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 153.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 153.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ABDOMEN COMPLETE", "code_information": [{"code": "76700", "type": "CPT"}, {"code": "5066700", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 616.98, "gross_charge": 2938.0, "discounted_cash": 2203.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 616.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 280.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 153.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": 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"UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US ABDOMEN LTD/QUAD/FU", "code_information": [{"code": "76705", "type": "CPT"}, {"code": "5016705", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 313.11, "gross_charge": 1491.0, "discounted_cash": 1118.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 313.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 208.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US BONE DENSITY MEASURE", "code_information": [{"code": "76977", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 108.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 86.56, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS 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"standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US BONE STIMULATION", "code_information": [{"code": "20979", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US BREAST UNI COMPLETE", "code_information": [{"code": "76641", "type": "CPT"}, {"code": "5016643", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 387.34, "gross_charge": 1080.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 387.34, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US BREAST UNI COMPLETE", "code_information": [{"code": "76641", "type": "CPT"}, {"code": "5066645", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 387.34, "gross_charge": 1308.0, "discounted_cash": 981.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 387.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO 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"standard_charges": [{"minimum": 0.5, "maximum": 320.08, "gross_charge": 869.0, "discounted_cash": 651.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 320.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US BREAST UNI LTD", "code_information": [{"code": "76642", "type": "CPT"}, {"code": "5066642", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 320.08, "gross_charge": 1634.0, "discounted_cash": 1225.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 320.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US CHEST INCLD MEDIASTNM", "code_information": [{"code": "76604", "type": "CPT"}, {"code": "5016604", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 182.07, "gross_charge": 867.0, "discounted_cash": 650.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 182.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 180.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 97.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE 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"standard_charge_dollar": 206.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US GUIDE VASCULAR ACCESS", "code_information": [{"code": "76937", "type": "CPT"}, {"code": "4616937", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 135.03, "gross_charge": 643.0, "discounted_cash": 482.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 135.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US GUIDE VASCULAR ACCESS", "code_information": [{"code": "76937", "type": "CPT"}, {"code": "4916937", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.29, "gross_charge": 349.0, "discounted_cash": 261.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 73.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP 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1.0, "maximum": 73.29, "gross_charge": 349.0, "discounted_cash": 261.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 73.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 63.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US INFANT HIPS DYNAMIC", "code_information": [{"code": "76885", "type": "CPT"}, {"code": "5066885", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 459.9, "gross_charge": 2190.0, "discounted_cash": 1642.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 459.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": 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"BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 144.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 144.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 144.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 144.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US LEIOMYOMATA ABLATE <200", "code_information": [{"code": "71T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for 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{"description": "US OB COMP W FETL ANATMY", "code_information": [{"code": "76811", "type": "CPT"}, {"code": "5066811", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 462.87, "gross_charge": 2005.0, "discounted_cash": 1503.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 421.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 462.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 248.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 248.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 248.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 248.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 248.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US OB COMP<14WK ADD GEST", "code_information": [{"code": "76802", "type": "CPT"}, {"code": "5066802", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 156.87, "gross_charge": 747.0, "discounted_cash": 560.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 156.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 135.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 86.53, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 86.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 86.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 86.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 86.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US OB COMP<14WKS 1STGEST", "code_information": [{"code": "76801", "type": "CPT"}, {"code": "5016801", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 309.54, "gross_charge": 1474.0, "discounted_cash": 1105.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 309.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 278.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 151.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 151.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 151.37, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 151.37, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 151.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US OB COMP<14WKS 1STGEST", "code_information": [{"code": "76801", "type": "CPT"}, {"code": "5066801", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 309.54, "gross_charge": 1474.0, "discounted_cash": 1105.5, "setting": "both", "payers_information": [{"payer_name": 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": 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458.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 128.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 132.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USE CONTRAST AGENT ECHO", "code_information": [{"code": "93352", "type": "CPT"}, {"code": "4603352", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 70.69, "maximum": 80.83, "gross_charge": 647.0, "discounted_cash": 485.25, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 72.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 70.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 80.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 80.83, "methodology": "fee schedule"}, {"payer_name": "BLUE 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SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 118344.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 49552.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36705.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 23861.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 118344.68, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 23861.16, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36705.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 49552.7, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 61043.81, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 97862.92, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 22612.25, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 19122.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 60082.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 75711.85, "methodology": "case 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[{"minimum": 118680.55, "maximum": 149553.51, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 118680.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149553.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "738", "type": "MS-DRG"}], "standard_charges": [{"minimum": 48757.14, "maximum": 61440.57, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 48757.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61440.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ultrasound Follow-Up Study", "code_information": [{"code": "76970", "type": "CPT"}], "standard_charges": [{"minimum": 88.78, "maximum": 88.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 88.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 88.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 88.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 88.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 88.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ultrasound exam aaa screen", "code_information": [{"code": "G0389", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Unite biomatrix", "code_information": [{"code": "Q4129", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Urine protein test doc rev", "code_information": [{"code": "G8770", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "V-BAND GASTROPLASTY", "code_information": [{"code": "43842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 27329.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1121.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23416.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26018.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1121.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1121.65, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1121.65, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VACC AIIV4 NO PRSRV 0.5ML IM", "code_information": [{"code": "90694", "type": "CPT"}], "standard_charges": [{"minimum": 73.29, "maximum": 81.43, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 73.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 81.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 81.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 81.43, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAG HYST COMPLEX", "code_information": [{"code": "58290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1136.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1136.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1136.88, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1136.88, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1136.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST INCL T/O COMPLEX", "code_information": [{"code": "58291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1232.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1232.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1232.97, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1232.97, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1232.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST INCLUDING T/O", "code_information": [{"code": "58262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "estimated_discounted_cash": 13552.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 907.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 907.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 907.21, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 907.21, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 907.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST T/O & REPAIR COMPL", "code_information": [{"code": "58292", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1301.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1301.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1301.76, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1301.76, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1301.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/ENTEROCELE COMPL", "code_information": [{"code": "58294", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1196.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1196.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1196.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1196.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1196.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/ENTEROCELE REPAIR", "code_information": [{"code": "58270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 870.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 870.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 870.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 870.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 870.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/T/O & VAG REPAIR", "code_information": [{"code": "58263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 976.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 976.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 976.46, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 976.46, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 976.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/URINARY REPAIR", "code_information": [{"code": "58267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1037.51, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1037.51, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1037.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1037.51, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1037.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC", "code_information": [{"code": "746", "type": "MS-DRG"}], "standard_charges": [{"minimum": 57675.19, "maximum": 72678.53, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 57675.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 72678.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "747", "type": "MS-DRG"}], "standard_charges": [{"minimum": 28543.76, "maximum": 35968.99, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28543.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35968.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C", "code_information": [{"code": "768", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.07, "maximum": 15936.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6194.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10255.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8356.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9286.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15936.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC", "code_information": [{"code": "797", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 15936.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6194.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10255.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8356.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9286.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15936.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC", "code_information": [{"code": "796", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.17, "maximum": 15936.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6194.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10255.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8356.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9286.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15936.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC", "code_information": [{"code": "798", "type": "MS-DRG"}], "standard_charges": [{"minimum": 0.96, "maximum": 15936.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6194.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10255.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8356.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9286.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15936.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC", "code_information": [{"code": "806", "type": "MS-DRG"}], "standard_charges": [{"minimum": 0.75, "maximum": 15936.0, "estimated_discounted_cash": 46722.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6194.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10255.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8356.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9286.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15936.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [{"code": "805", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.08, "maximum": 15936.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6194.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10255.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8356.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9286.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15936.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC", "code_information": [{"code": "807", "type": "MS-DRG"}], "standard_charges": [{"minimum": 0.67, "maximum": 15936.0, "estimated_discounted_cash": 50310.93, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6194.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 10255.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8356.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9286.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15936.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY", "code_information": [{"code": "58260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 812.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 812.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 812.96, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 812.96, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 812.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINECTOMY PARTIAL W/NODES", "code_information": [{"code": "57109", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1555.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1555.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1555.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1555.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1555.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGOTOMY & PYLORUS REPAIR", "code_information": [{"code": "43640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1067.15, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1067.15, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1067.15, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1067.15, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1067.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGOTOMY & PYLORUS REPAIR", "code_information": [{"code": "43641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1084.59, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1084.59, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1084.59, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1084.59, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1084.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VALACYCLOVIR 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312258", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VALACYCLOVIR 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312258", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VALGANCICLOV PED DOSE LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316575", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VALGANCICLOV PED DOSE LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316575", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VALGANCICLOVIR 450MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312263", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 32.25, "setting": "both", "billing_class": "facility"}]}, {"description": "VALGANCICLOVIR 450MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312263", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 32.25, "setting": "both", "billing_class": "facility"}]}, {"description": "VALPROATE 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312261", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VALPROATE 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312261", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VALPROATE 250MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316585", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VALPROATE 250MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316585", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VALPROATE250MG/5ML10MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316582", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 55.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VALPROATE250MG/5ML10MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316582", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 55.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VALPROIC ACID FREE", "code_information": [{"code": "80165", "type": "CPT"}, {"code": "7250165", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.17, "gross_charge": 426.0, "discounted_cash": 319.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALPROIC ACID TOTAL", "code_information": [{"code": "80164", "type": "CPT"}, {"code": "4104584", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.09, "gross_charge": 426.0, "discounted_cash": 319.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALPROIC ACID TOTAL", "code_information": [{"code": "80164", "type": "CPT"}, {"code": "7254584", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.09, "gross_charge": 77.0, "discounted_cash": 57.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.09, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALRUBICIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9357", "type": "HCPCS"}], "standard_charges": [{"minimum": 1191.02, "maximum": 1323.35, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1191.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1323.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1323.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1323.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1323.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALSARTAN 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312262", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VALSARTAN 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312262", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VALSARTAN 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312265", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 18.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VALSARTAN 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312265", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 18.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVULOPLASTY AORTIC VALVE", "code_information": [{"code": "33390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY AORTIC VALVE", "code_information": [{"code": "33391", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": "33463", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2812.09, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2812.09, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2812.09, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2812.09, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2812.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": "33464", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2319.57, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2319.57, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2319.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2319.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2319.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN", "code_information": [{"code": "80202", "type": "CPT"}, {"code": "4100031", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.09, "gross_charge": 180.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN 125MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312270", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 125MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312270", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 125MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316591", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 125MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316591", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312271", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312271", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 25MG/ML 150ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316606", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 439.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 25MG/ML 150ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316606", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 439.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 25MG/ML 300ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316607", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 594.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN 25MG/ML 300ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316607", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 594.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316602", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316602", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}, {"code": "5325062", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.21, "discounted_cash": 0.16, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}, {"code": "5325062", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.21, "discounted_cash": 0.16, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN PER 10MG IVPB IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}, {"code": "5325063", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.84, "discounted_cash": 0.63, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN PER 10MG IVPB IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}, {"code": "5325063", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.84, "discounted_cash": 0.63, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN PER 10MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}, {"code": "5325064", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.63, "discounted_cash": 0.47, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN PER 10MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}, {"code": "5325064", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "gross_charge": 0.63, "discounted_cash": 0.47, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN/2", "code_information": [{"code": "80202", "type": "CPT"}, {"code": "4100032", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.09, "gross_charge": 180.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN/3", "code_information": [{"code": "80202", "type": "CPT"}, {"code": "4100033", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.09, "gross_charge": 180.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 69.09, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN250MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316594", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN250MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316594", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VANOMYCIN DNA AMP PROBE", "code_information": [{"code": "87500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 152.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 152.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 36.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA VIRUS VACC IJ", "code_information": [{"code": "90716", "type": "CPT"}, {"code": "5319190", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 207.35, "maximum": 230.39, "gross_charge": 884.0, "discounted_cash": 663.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.7, "gross_charge": 520.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.7, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA ZOSTER AB/2", "code_information": [{"code": "86787", "type": "CPT"}, {"code": "4106786", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.7, "gross_charge": 513.0, "discounted_cash": 384.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}], "billing_class": 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{"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA ZOSTER AB/3", "code_information": [{"code": "86787", "type": "CPT"}, {"code": "7256786", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.7, "gross_charge": 74.0, "discounted_cash": 55.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA ZOSTER AB/4", "code_information": [{"code": "86787", "type": "CPT"}, {"code": "7256788", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.7, "gross_charge": 520.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA ZOSTER AB/5", "code_information": [{"code": "86787", "type": "CPT"}, {"code": "7250691", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.7, "gross_charge": 71.0, "discounted_cash": 53.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA ZOSTER DFA", "code_information": [{"code": "87290", "type": "CPT"}, {"code": "7258729", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.17, "gross_charge": 225.0, "discounted_cash": 168.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 61.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA-ZOSTER IG IM", "code_information": [{"code": "90396", "type": "CPT"}], "standard_charges": [{"minimum": 2340.05, "maximum": 2600.06, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 2340.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 2600.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 2600.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 2600.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 2600.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAS CLS ANGSL 6FR 610130", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "8243891", "type": "CDM"}], "standard_charges": [{"minimum": 2431.17, "maximum": 2431.17, "gross_charge": 11577.0, "discounted_cash": 8682.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2431.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAS CLS ART CLOSER S", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "8249010", "type": "CDM"}], "standard_charges": [{"minimum": 354.06, "maximum": 354.06, "gross_charge": 1686.0, "discounted_cash": 1264.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 354.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAS CLS ART PERCLOSE", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "8240408", "type": "CDM"}], "standard_charges": [{"minimum": 233.73, "maximum": 233.73, "gross_charge": 1113.0, "discounted_cash": 834.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 233.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC EMB/OCC ARTERY", "code_information": [{"code": "4617242", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 50838.0, "discounted_cash": 38128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMB/OCC ARTERY", "code_information": [{"code": "4917242", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 45714.0, "discounted_cash": 34285.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMB/OCC BLEED", "code_information": [{"code": "4917244", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 38560.0, "discounted_cash": 28920.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMB/OCC ORGAN", "code_information": [{"code": "4917243", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 38560.0, "discounted_cash": 28920.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMB/OCC VENOUS", "code_information": [{"code": "4617241", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 71746.0, "discounted_cash": 53809.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMB/OCC VENOUS", "code_information": [{"code": "4917241", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 47799.0, "discounted_cash": 35849.25, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE ARTERY", "code_information": [{"code": "37242", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE BLEED", "code_information": [{"code": "37244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE ORGAN", "code_information": [{"code": "37243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE VENOUS", "code_information": [{"code": "37241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASC GRAFT INTO CARPAL BONE", "code_information": [{"code": "25430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1175.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASCULAR FLOW STUDY IMAG", "code_information": [{"code": "78445", "type": "CPT"}, {"code": "5208445", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 705.18, "gross_charge": 3358.0, "discounted_cash": 2518.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 705.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 319.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 170.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 170.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 170.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 170.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 170.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOACTIVE INTST POLYPEP", "code_information": [{"code": "84586", "type": "CPT"}, {"code": "7254238", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 180.2, "gross_charge": 202.0, "discounted_cash": 151.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 180.2, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 26.68, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 26.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 26.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 26.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 26.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOPNEUMATIC DEVICE THERAPY", "code_information": [{"code": "97016", "type": "CPT"}], "standard_charges": [{"minimum": 12.7, "maximum": 29.45, "estimated_discounted_cash": 256.8, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 26.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 25.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 29.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 29.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 29.45, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOPRESSIN (ADH)", "code_information": [{"code": "84588", "type": "CPT"}, {"code": "7254588", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 173.12, "gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 173.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 47.43, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 47.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 47.43, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 47.43, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 47.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC CARE AFTER DELIVERY", "code_information": [{"code": "59614", "type": "CPT"}], "standard_charges": [{"minimum": 960.12, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 960.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 960.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 960.12, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 960.12, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 960.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC CLASS", "code_information": [{"code": "S9439", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VBAC DELIVERY", "code_information": [{"code": "59610", "type": "CPT"}], "standard_charges": [{"minimum": 1848.42, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1848.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1848.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1848.42, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1848.42, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1848.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC DELIVERY ONLY", "code_information": [{"code": "59612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 857.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 857.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 857.25, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 857.25, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 857.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEDOLIZUMAB", "code_information": [{"code": "80280", "type": "CPT"}, {"code": "7250012", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 38.57, "maximum": 38.57, "gross_charge": 286.0, "discounted_cash": 214.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR INMT MNTR", "code_information": [{"code": "95712", "type": "CPT"}, {"code": "4805708", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 330.36, "maximum": 377.79, "gross_charge": 2094.0, "discounted_cash": 1570.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 340.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 330.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 377.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 377.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 377.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR UNMNTR", "code_information": [{"code": "95711", "type": "CPT"}, {"code": "4805707", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 330.36, "maximum": 377.79, "gross_charge": 2094.0, "discounted_cash": 1570.5, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 340.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 330.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 377.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 377.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 377.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12HR CONT MNTR", "code_information": [{"code": "95713", "type": "CPT"}, {"code": "4805709", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 633.85, "maximum": 724.86, "gross_charge": 4020.0, "discounted_cash": 3015.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 652.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 633.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 724.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 724.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 724.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26 HR INTMT MNTR", "code_information": [{"code": "95715", "type": "CPT"}, {"code": "4805711", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 633.85, "maximum": 724.86, "gross_charge": 4020.0, "discounted_cash": 3015.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 652.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 633.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 724.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 724.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 724.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26 HR UNMNTR", "code_information": [{"code": "95714", "type": "CPT"}, {"code": "4805710", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 633.85, "maximum": 724.86, "gross_charge": 4020.0, "discounted_cash": 3015.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 652.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 633.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 724.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 724.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 724.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26HR CONT MNTR", "code_information": [{"code": "95716", "type": "CPT"}, {"code": "4805712", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1186.41, "maximum": 1356.76, "gross_charge": 7524.0, "discounted_cash": 5643.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1221.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1186.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1356.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1356.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1356.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN BYP FEM-TIBIAL PERONEAL", "code_information": [{"code": "35585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1734.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1734.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1734.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1734.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1734.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35583", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1470.72, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1470.72, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1470.72, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1470.72, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1470.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN BYP POP-TIBL PERONEAL", "code_information": [{"code": "35587", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1455.32, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1455.32, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1455.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1455.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1455.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN LIGATION AND STRIPPING", "code_information": [{"code": "263", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9704.76, "maximum": 127918.56, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 25532.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 20142.73, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32390.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 59776.58, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 62898.81, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 21194.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 26866.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34082.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 22381.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 28369.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 35990.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 66419.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 28369.83, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 66419.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 35990.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 22381.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 22381.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 66419.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 35990.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 28369.83, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 12432.63, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 36529.49, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9704.76, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 17318.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 101511.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 127918.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY EYE SOCKET", "code_information": [{"code": "75880", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 541.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 180.63, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 127.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 127.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 127.86, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 127.86, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 127.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 541.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 541.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VELAGLUCERASE ALFA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3385", "type": "HCPCS"}], "standard_charges": [{"minimum": 343.22, "maximum": 381.36, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 343.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 381.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 381.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 381.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 381.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R CERVICAL", "code_information": [{"code": "92517", "type": "CPT"}], "standard_charges": [{"minimum": 191.11, "maximum": 218.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 196.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 191.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 218.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 218.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 218.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R OCULAR", "code_information": [{"code": "92518", "type": "CPT"}], "standard_charges": [{"minimum": 191.11, "maximum": 218.55, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 196.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 191.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 218.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 218.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 218.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TST I&R CERVICAL&OCULAR", "code_information": [{"code": "92519", "type": "CPT"}], "standard_charges": [{"minimum": 362.27, "maximum": 414.28, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 372.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 362.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 414.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 414.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 414.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN MECHNL THRMBC REPEAT TX", "code_information": [{"code": "37188", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17747.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEN THROMBOSIS IMAGES BILAT", "code_information": [{"code": "78458", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 492.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 492.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 242.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 242.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 242.13, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 242.13, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 242.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENA CAVA FILT", "code_information": [{"code": "C1880", "type": "HCPCS"}, {"code": "8145750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1281.84, "maximum": 1281.84, "gross_charge": 6104.0, "discounted_cash": 4578.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1281.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "4109009", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 3.0, "maximum": 58.0, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "6106415", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 3.0, "maximum": 58.0, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "6926416", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 3.0, "maximum": 58.0, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 58.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN 1 YR/>", "code_information": [{"code": "36425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 9.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 9.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 9.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 9.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 9.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN < 1 YR", "code_information": [{"code": "36420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE HOME/SNF", "code_information": [{"code": "S9529", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENLAFAXINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312275", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VENLAFAXINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312275", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VENLAFAXINE 37.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312276", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VENLAFAXINE 37.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312276", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VENLAFAXINE 37.5MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312273", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VENLAFAXINE 37.5MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312273", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VENLAFAXINE 75MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312274", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "VENLAFAXINE 75MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312274", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "VENOGRAM EXTREMITY BI", "code_information": [{"code": "75822", "type": "CPT"}, {"code": "4615823", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1406.14, "gross_charge": 4491.0, "discounted_cash": 3368.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 943.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 233.32, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 155.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee 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schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOGRAM EXTREMITY BI", "code_information": [{"code": "75822", "type": "CPT"}, {"code": "4915823", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1406.14, "gross_charge": 6385.0, "discounted_cash": 4788.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1340.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 233.32, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 155.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 155.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 155.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 155.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 155.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOGRAM EXTREMITY UNI", "code_information": [{"code": "75820", "type": "CPT"}, {"code": "4615821", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1406.14, "gross_charge": 4688.0, "discounted_cash": 3516.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 984.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 180.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOGRAM EXTREMITY UNI", "code_information": [{"code": "75820", "type": "CPT"}, {"code": "4905970", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1406.14, "gross_charge": 5402.0, "discounted_cash": 4051.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1134.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 180.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 122.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 122.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 122.8, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 122.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOGRAM EXTREMITY UNI", "code_information": [{"code": "75820", "type": "CPT"}, {"code": "4915821", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 1406.14, "gross_charge": 4688.0, "discounted_cash": 3516.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 984.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 180.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 122.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, 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"standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1732.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENOUS SAMPLING VIA CATH", "code_information": [{"code": "75893", "type": "CPT"}, {"code": "4915893", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 4770.37, "gross_charge": 12246.0, "discounted_cash": 9184.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2571.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1270.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 398.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 398.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 398.92, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 398.92, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 398.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENT MGMT NF PER DAY", "code_information": [{"code": "94004", "type": "CPT"}], "standard_charges": [{"minimum": 45.93, "maximum": 45.93, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 45.93, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 45.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 45.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 45.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 45.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENT NEONATAL INITIAL", "code_information": [{"code": "94002", "type": "CPT"}, {"code": "5505020", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 86.29, "maximum": 794.29, "gross_charge": 5571.0, "discounted_cash": 4178.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 714.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 694.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITH CC", "code_information": [{"code": "32", "type": "MS-DRG"}], "standard_charges": [{"minimum": 70753.46, "maximum": 89158.91, "estimated_discounted_cash": 91041.84, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 70753.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 89158.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "31", "type": "MS-DRG"}], "standard_charges": [{"minimum": 148761.56, "maximum": 187459.64, "estimated_discounted_cash": 227756.8, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 148761.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 187459.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "33", "type": "MS-DRG"}], "standard_charges": [{"minimum": 55211.61, "maximum": 69574.07, "estimated_discounted_cash": 101085.02, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55211.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 69574.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VER DOC HEAR LOSS", "code_information": [{"code": "G8565", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VERAPAMIL 120MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312288", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 120MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312288", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 120MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312291", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 120MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312291", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 120MG XR24 CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312286", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 120MG XR24 CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312286", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 180MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312290", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 180MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312290", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 180MG XR24 CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312302", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 180MG XR24 CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312302", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 240 XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312289", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 240 XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312289", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312283", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312283", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312284", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VERAPAMIL 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312284", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VERITAS COLLAGEN MATRIX, CM2", "code_information": [{"code": "C9354", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL AXIAL DECOMPRESSIO", "code_information": [{"code": "S9090", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VERTEBROPLASTY ADDL INJECT", "code_information": [{"code": "22512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VERTEPORFIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3396", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.39, "maximum": 11.54, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERTICAL ELECTRODES", "code_information": [{"code": "92547", "type": "CPT"}, {"code": "4802547", "type": "CDM"}, {"code": "471", "type": "RC"}], "standard_charges": [{"minimum": 5.94, "maximum": 5.94, "gross_charge": 1006.0, "discounted_cash": 754.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERY LNG CHN FATTY ACID", "code_information": [{"code": "82726", "type": "CPT"}, {"code": "7259920", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.09, "gross_charge": 289.0, "discounted_cash": 216.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VESTIBULAR DEV IMPLTJ UNI", "code_information": [{"code": "725T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VESTIBULAR REHAB PER DIEM", "code_information": [{"code": "S9476", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VILAZODONE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312332", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VILAZODONE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312332", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VIRAL ILLNESS WITH MCC", "code_information": [{"code": "865", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49746.56, "maximum": 62687.37, "estimated_discounted_cash": 63580.04, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49746.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 62687.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [{"code": "866", "type": "MS-DRG"}], "standard_charges": [{"minimum": 28872.46, "maximum": 36383.19, "estimated_discounted_cash": 57760.1, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28872.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36383.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL MENINGITIS WITH CC/MCC", "code_information": [{"code": "75", "type": "MS-DRG"}], "standard_charges": [{"minimum": 63664.83, "maximum": 80226.28, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63664.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80226.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL MENINGITIS WITHOUT CC/MCC", "code_information": [{"code": "76", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27398.29, "maximum": 34525.54, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27398.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34525.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRUS INOC SHELL EACH/2", "code_information": [{"code": "87254", "type": "CPT"}, {"code": "7257253", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.72, "gross_charge": 268.0, "discounted_cash": 201.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 99.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOC SHELL EACH/3", "code_information": [{"code": "87254", "type": "CPT"}, {"code": "7257255", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.72, "gross_charge": 366.0, "discounted_cash": 274.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 99.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOC SHELL EACH/7", "code_information": [{"code": "87254", "type": "CPT"}, {"code": "7257258", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.72, "gross_charge": 113.0, "discounted_cash": 84.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 99.72, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATE EGGS/ANIMAL", "code_information": [{"code": "87250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 99.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 1 PROSTH", "code_information": [{"code": "34845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 2 PROSTH", "code_information": [{"code": "34846", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 3 PROSTH", "code_information": [{"code": "34847", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 4+ PROST", "code_information": [{"code": "34848", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISCOSITY", "code_information": [{"code": "85810", "type": "CPT"}, {"code": "7257192", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 59.57, "gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 59.57, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.32, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.32, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.32, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISIT ESKETAMINE 56M OR LESS", "code_information": [{"code": "G2082", "type": "HCPCS"}], "standard_charges": [{"minimum": 880.65, "maximum": 1007.09, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 906.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 880.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1007.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1007.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1007.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISIT ESKETAMINE, > 56M", "code_information": [{"code": "G2083", "type": "HCPCS"}], "standard_charges": [{"minimum": 1286.78, "maximum": 1471.53, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1324.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1286.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1471.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1471.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1471.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISIT TO DETERM LDCT ELIG", "code_information": [{"code": "G0296", "type": "HCPCS"}], "standard_charges": [{"minimum": 104.05, "maximum": 118.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 104.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 118.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 118.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 118.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL ACUITY SCREEN", "code_information": [{"code": "99173", "type": "CPT"}], "standard_charges": [{"minimum": 3.06, "maximum": 6.91, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 6.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 6.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 6.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 6.91, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3.06, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3.06, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL AUDIOMETRY (VRA)", "code_information": [{"code": "92579", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL EP TEST FOR GLAUCOMA", "code_information": [{"code": "464T", "type": "CPT"}], "standard_charges": [{"minimum": 185.16, "maximum": 211.75, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL EVOKED POTENTIAL", "code_information": [{"code": "95930", "type": "CPT"}, {"code": "4805871", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 125.62, "maximum": 211.75, "gross_charge": 2350.0, "discounted_cash": 1762.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 125.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 125.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 125.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 125.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 125.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUALIZATION OF WINDPIPE", "code_information": [{"code": "31615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 444.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIT D1 25-DIHYDROXY", "code_information": [{"code": "82652", "type": "CPT"}, {"code": "7254594", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 196.3, "gross_charge": 335.0, "discounted_cash": 251.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 196.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 53.78, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 53.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 53.78, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 53.78, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 53.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT FOR MACULAR HOLE", "code_information": [{"code": "67042", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIT FOR MACULAR PUCKER", "code_information": [{"code": "67041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIT FOR MEMBRANE DISSECT", "code_information": [{"code": "67043", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1662.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITAL CAPACITY", "code_information": [{"code": "94150", "type": "CPT"}, {"code": "5501213", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 24.62, "maximum": 211.75, "gross_charge": 496.0, "discounted_cash": 372.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAL CAPACITY", "code_information": [{"code": "94150", "type": "CPT"}, {"code": "6704150", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 24.62, "maximum": 211.75, "gross_charge": 496.0, "discounted_cash": 372.0, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 185.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 211.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN A", "code_information": [{"code": "84590", "type": "CPT"}, {"code": "7254590", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 59.13, "gross_charge": 355.0, "discounted_cash": 266.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 59.13, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN D SRM MICROSAMP QUAN", "code_information": [{"code": "38U", "type": "CPT"}], "standard_charges": [{"minimum": 29.6, "maximum": 29.6, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN D/25 HYDROXY", "code_information": [{"code": "82306", "type": "CPT"}, {"code": "4104595", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 150.96, "gross_charge": 1529.0, "discounted_cash": 1146.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 150.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN D/25 HYDROXY/2", "code_information": [{"code": "82306", "type": "CPT"}, {"code": "4104596", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 150.96, "gross_charge": 540.0, "discounted_cash": 405.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 150.96, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN K", "code_information": [{"code": "84597", 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"methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN NOS", "code_information": [{"code": "84591", "type": "CPT"}, {"code": "7254589", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 59.13, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 59.13, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", 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"standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN SUPPL 100 CAPS", "code_information": [{"code": "S0194", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VITAMN E(TOCOPHRL ALPHA)", "code_information": [{"code": "84446", "type": "CPT"}, {"code": "7254446", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.31, "gross_charge": 180.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 72.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITB12 UNSAT", "code_information": [{"code": "82608", "type": "CPT"}, {"code": "7252608", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.04, "gross_charge": 219.0, "discounted_cash": 164.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 73.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIVAGLOBIN, INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1562", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.53, "maximum": 7.25, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 6.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VKORC1 COMMON VARIANT", "code_information": [{"code": "81355", "type": "CPT"}, {"code": "7010135", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 88.2, "maximum": 88.2, "gross_charge": 1297.0, "discounted_cash": 972.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VKORC1 COMMON VARIANT/2", "code_information": [{"code": "81355", "type": "CPT"}, {"code": "7010136", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 88.2, "maximum": 88.2, "gross_charge": 1415.0, "discounted_cash": 1061.25, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLCAD LEUK NZM ACTV WHL BLD", "code_information": [{"code": "257U", "type": "CPT"}], "standard_charges": [{"minimum": 712.47, "maximum": 712.47, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 712.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 712.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLV HAKIM BACTISEAL", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8145792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.49, "maximum": 203.49, "gross_charge": 969.0, "discounted_cash": 726.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 203.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLV HAKIM PROGRAMABLE", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8145794", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6266.19, "maximum": 6266.19, "gross_charge": 29839.0, "discounted_cash": 22379.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6266.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLV HYDROCEPH", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8177945", "type": "CDM"}], "standard_charges": [{"minimum": 6421.17, "maximum": 6421.17, "gross_charge": 30577.0, "discounted_cash": 22932.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 6421.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLV TRACH SPEAK", "code_information": [{"code": "L8501", "type": "HCPCS"}, {"code": "8207551", "type": "CDM"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 342.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VLVT PV CLSD HRT VIA P-ART", "code_information": [{"code": "33471", "type": "CPT"}], "standard_charges": [{"minimum": 1372.68, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1372.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1372.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1372.68, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1372.68, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1372.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VMA URINE", "code_information": [{"code": "84585", "type": "CPT"}, {"code": "7254585", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 79.06, "gross_charge": 314.0, "discounted_cash": 235.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 79.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VMA URINE/2", "code_information": [{"code": "84585", "type": "CPT"}, {"code": "7258458", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 79.06, "gross_charge": 225.0, "discounted_cash": 168.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 79.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD ANOM/PERSIST SVC", "code_information": [{"code": "93584", "type": "CPT"}], "standard_charges": [{"minimum": 4200.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD AZYGS/HEMIAZYGS", "code_information": [{"code": "93585", "type": "CPT"}], "standard_charges": [{"minimum": 4200.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD CORONARY SINUS", "code_information": [{"code": "93586", "type": "CPT"}], "standard_charges": [{"minimum": 4200.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD VNVN CLTRL AT/ABV", "code_information": [{"code": "93587", "type": "CPT"}], "standard_charges": [{"minimum": 4200.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD VNVN CLTRL BELOW", "code_information": [{"code": "93588", "type": "CPT"}], "standard_charges": [{"minimum": 4200.0, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VOL REDUCTION OF BLOOD/PROD", "code_information": [{"code": "86960", "type": "CPT"}], "standard_charges": [{"minimum": 149.16, "maximum": 149.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLATILES", "code_information": [{"code": "84600", "type": "CPT"}, {"code": "7254600", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 81.94, "gross_charge": 143.0, "discounted_cash": 107.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 81.94, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 22.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLTAGE GATED CALCIUM", "code_information": [{"code": "86596", "type": "CPT"}, {"code": "7253576", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "gross_charge": 114.0, "discounted_cash": 85.5, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLTAGE GATED CALCIUM/2", "code_information": [{"code": "86596", "type": "CPT"}, {"code": "7253587", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "gross_charge": 349.0, "discounted_cash": 261.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLUME DEPLETE OF HARVEST", "code_information": [{"code": "38214", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 44.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 44.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 44.53, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 44.53, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 44.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VOLUME MEASURMNT URINE", "code_information": [{"code": "81050", "type": "CPT"}, {"code": "4101060", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.29, "gross_charge": 112.0, "discounted_cash": 84.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 4.19, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 4.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 4.19, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 4.19, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 4.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLUME VENT SUBSQ/DLY", "code_information": [{"code": "94003", "type": "CPT"}, {"code": "5500626", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 63.3, "maximum": 794.29, "gross_charge": 1507.0, "discounted_cash": 1130.25, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 714.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 694.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLUME VENTILATOR INTL", "code_information": [{"code": "94002", "type": "CPT"}, {"code": "5500620", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 86.29, "maximum": 794.29, "gross_charge": 1238.0, "discounted_cash": 928.5, "setting": "both", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 714.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 694.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 794.29, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VON WILLEBRANDFC PER1UIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7187", "type": "HCPCS"}, {"code": "5325246", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.34, "maximum": 1.49, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VONVENDI INJ 1 IU VWF:RCO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7179", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.67, "maximum": 1.85, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE", "code_information": [{"code": "80285", "type": "CPT"}, {"code": "7250015", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 27.11, "maximum": 27.11, "gross_charge": 201.0, "discounted_cash": 150.75, "setting": "both", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312451", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VORICONAZOLE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312451", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VRT BDY TETHERING ANT 8+ SEG", "code_information": [{"code": "657T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VRT BDY TETHERING ANT <7 SEG", "code_information": [{"code": "656T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VW FACTOR TYPE 2B EVAL PLSM", "code_information": [{"code": "283U", "type": "CPT"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VW FACTOR TYPE 2N EVAL PLSM", "code_information": [{"code": "284U", "type": "CPT"}], "standard_charges": [{"minimum": 17.27, "maximum": 17.27, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VYJUVEK 5X10^9PFU/ML, 0.1 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3401", "type": "HCPCS"}], "standard_charges": [{"minimum": 922.9, "maximum": 1025.44, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 922.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1025.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1025.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1025.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1025.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vadadustat, oral, 1 mg (for ESRD on dialysis)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0901", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.13, "maximum": 0.14, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vaginal Removal Of Uterus (Greater Than 250 Grams) With Repair For Stress Incontinence", "code_information": [{"code": "58293", "type": "CPT"}], "standard_charges": [{"minimum": 1352.33, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1352.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1352.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1352.33, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1352.33, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1352.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vasc emb/occ w/prs cath", "code_information": [{"code": "C9797", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 11202.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10082.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11202.0, "methodology": "per diem"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vertebroplast cerv 1st", "code_information": [{"code": "S2360", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Vertebroplast cerv addl", "code_information": [{"code": "S2361", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Vessel mapping hemo access", "code_information": [{"code": "G0365", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Voice current status", "code_information": [{"code": "G9171", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Voice d/c status", "code_information": [{"code": "G9173", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Voice goal status", "code_information": [{"code": "G9172", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Vte given upon admission", "code_information": [{"code": "G9201", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WARF OR OTHER FDA DRUG PRESC", "code_information": [{"code": "G8967", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WARFARIN 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312481", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WARFARIN 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312481", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WARFARIN 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312480", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WARFARIN 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312480", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WARFARIN 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312484", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WARFARIN 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312484", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WARFARIN 3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312483", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WARFARIN 3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312483", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WARFARIN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312488", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WARFARIN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312488", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WARFARIN RESPON GENETIC TEST", "code_information": [{"code": "G9143", "type": "HCPCS"}], "standard_charges": [{"minimum": 120.72, "maximum": 120.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 120.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 120.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASH HARVEST STEM CELLS", "code_information": [{"code": "38209", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3243.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 512.19, "maximum": 512.19, "gross_charge": 2439.0, "discounted_cash": 1829.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 512.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER CANCL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 38.01, "maximum": 38.01, "gross_charge": 181.0, "discounted_cash": 135.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 38.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WATER STERL INJ .5L IVF", "code_information": [{"code": "A4217", "type": "HCPCS"}, {"code": "5412785", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 17.0, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WATER STERL INJ 1L IVF", "code_information": [{"code": "A4217", "type": "HCPCS"}, {"code": "5412790", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"minimum": 24.0, "maximum": 24.0, "gross_charge": 24.0, "discounted_cash": 18.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WATER STERL INJ 2L IVF", "code_information": [{"code": "A4217", "type": "HCPCS"}, {"code": "5412795", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"minimum": 25.0, "maximum": 25.0, "gross_charge": 25.0, "discounted_cash": 18.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 25.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WATERJET PROSTATE ABLTJ CMPL", "code_information": [{"code": "421T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "estimated_discounted_cash": 25403.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WBC ANTIBODY IDENTIFICATION", "code_information": [{"code": "86021", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 76.76, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 21.03, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 21.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 21.03, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 21.03, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 21.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WBC AUTO", "code_information": [{"code": "85048", "type": "CPT"}, {"code": "4105013", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 12.96, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12.96, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 3.55, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 3.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 3.55, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 3.55, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 3.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WC VAN MILEAGE PER MI", "code_information": [{"code": "S0209", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WCD DEVICE INTERROGATE", "code_information": [{"code": "93292", "type": "CPT"}], "standard_charges": [{"minimum": 50.61, "maximum": 57.87, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 52.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 50.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE ALLOGRAFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137088", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 769.02, "maximum": 769.02, "gross_charge": 3662.0, "discounted_cash": 2746.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 769.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE BIOPSY OF LIVER", "code_information": [{"code": "47100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 766.66, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 766.66, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 766.66, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 766.66, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 766.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEDGE OSTEOTOMY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4018095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2984.94, "maximum": 2984.94, "gross_charge": 14214.0, "discounted_cash": 10660.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2984.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG ADD-ON", "code_information": [{"code": "32506", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG DIAG", "code_information": [{"code": "32507", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG INITIAL", "code_information": [{"code": "32505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEDGING OF CAST", "code_information": [{"code": "29740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 40.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 40.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 40.08, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 40.08, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 40.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEDGING OF CLUBFOOT CAST", "code_information": [{"code": "29750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEIGHT MGMT CLASS", "code_information": [{"code": "S9449", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WELLNESS ASSESSMENT BY NONPH", "code_information": [{"code": "S5190", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS", "code_information": [{"code": "86789", "type": "CPT"}, {"code": "4100291", 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{"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS IGM", "code_information": [{"code": "86788", "type": "CPT"}, {"code": "7256783", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.92, "gross_charge": 520.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 85.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, 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"BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1006.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1006.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE BODY LOW DOSE CT", "code_information": [{"code": "76497", "type": "CPT"}, {"code": "5050006", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 80.9, "maximum": 717.57, "gross_charge": 3417.0, "discounted_cash": 2562.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 717.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE BODY PHOTOGRAPHY", "code_information": [{"code": "96904", "type": "CPT"}], "standard_charges": [{"minimum": 87.75, "maximum": 87.75, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE MITOCHONDRIAL GENOME", "code_information": [{"code": "81465", "type": "CPT"}], "standard_charges": [{"minimum": 936.0, "maximum": 936.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WILATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7183", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.16, "maximum": 1.29, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 1.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 1.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 1.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 1.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 1.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WINDOWING OF CAST", "code_information": [{"code": "29730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 28.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 557.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 620.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 28.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 28.31, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 28.31, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 28.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WIRE FIXATON COM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8177985", "type": "CDM"}], "standard_charges": [{"minimum": 75.39, "maximum": 75.39, "gross_charge": 359.0, "discounted_cash": 269.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 75.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE GUIDEPINCAL", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8137090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 111.09, "maximum": 111.09, "gross_charge": 529.0, "discounted_cash": 396.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 111.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE KIRCHNER PL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1919.19, "maximum": 1919.19, "gross_charge": 9139.0, "discounted_cash": 6854.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1919.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER W STOP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 39.9, "maximum": 39.9, "gross_charge": 190.0, "discounted_cash": 142.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 39.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIREGDE AMPLTZ", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8177990", "type": "CDM"}], "standard_charges": [{"minimum": 44.73, "maximum": 44.73, "gross_charge": 213.0, "discounted_cash": 159.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 44.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WND PREP ADDL 100SQCM", "code_information": [{"code": "6906900", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4240.0, "discounted_cash": 3180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP ADDL 100SQCM", "code_information": [{"code": "6906900", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 4240.0, "discounted_cash": 3180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G", "code_information": [{"code": "6900128", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G", "code_information": [{"code": "6900128", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3796.0, "discounted_cash": 2847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G ADDL CM", "code_information": [{"code": "15005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G ADDL O", "code_information": [{"code": "6900129", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4825.0, "discounted_cash": 3618.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G ADDL O", "code_information": [{"code": "6900129", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 4825.0, "discounted_cash": 3618.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WORK HARDENING", "code_information": [{"code": "97545", "type": "CPT"}], "standard_charges": [{"minimum": 114.82, "maximum": 329.92, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 114.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 296.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 288.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 329.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 329.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 329.92, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 114.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 114.82, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 114.82, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 114.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WORK HARDENING ADD-ON", "code_information": [{"code": "97546", "type": "CPT"}], "standard_charges": [{"minimum": 57.41, "maximum": 57.41, "setting": "outpatient", "payers_information": [{"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 57.41, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 57.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 57.41, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 57.41, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 57.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND CLOSURE BY ADHESIVE", "code_information": [{"code": "G0168", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7835.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 7835.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "464", "type": "MS-DRG"}], "standard_charges": [{"minimum": 103414.27, "maximum": 130315.93, "estimated_discounted_cash": 102014.35, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 103414.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 130315.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "463", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4753.88, "maximum": 238461.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 23154.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 8819.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 14883.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11083.41, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9279.69, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 24364.24, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 15660.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 11662.31, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 16537.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12315.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 9799.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 25727.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 25727.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 9799.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 16537.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12315.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 16537.5, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 25727.85, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 9799.05, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12315.02, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 9038.12, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5969.75, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4753.88, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 15832.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 189234.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 238461.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "465", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4676.91, "maximum": 76301.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 32811.95, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 9289.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 11414.02, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 18889.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 9775.23, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 34525.78, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 19876.09, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 12010.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 10322.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 20988.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 12682.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 36458.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 20988.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 36458.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 12682.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 10322.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 12682.38, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 36458.11, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 20988.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 10322.32, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 10696.24, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 5209.18, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 15180.07, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MEDICAID", "standard_charge_dollar": 4676.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 60550.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 76301.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [{"code": "902", "type": "MS-DRG"}], "standard_charges": [{"minimum": 63565.23, "maximum": 80100.77, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63565.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80100.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH MCC", "code_information": [{"code": "901", "type": "MS-DRG"}], "standard_charges": [{"minimum": 139335.51, "maximum": 175581.55, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 139335.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 175581.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "903", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38833.06, "maximum": 48934.89, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38833.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 48934.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND PREP ADDL 100 CM", "code_information": [{"code": "15003", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND PREP F/N/HF/G", "code_information": [{"code": "15004", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 4249.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND PREP TRK/ARM/LEG", "code_information": [{"code": "6900140", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6213.0, "discounted_cash": 4659.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND PREP TRK/ARM/LEG", "code_information": [{"code": "6900140", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 6213.0, "discounted_cash": 4659.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND PREP TRK/ARM/LEG", "code_information": [{"code": "15002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "estimated_discounted_cash": 5480.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4347.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST 2 VIEWS", "code_information": [{"code": "73100", "type": "CPT"}, {"code": "4903100", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 205.8, "gross_charge": 980.0, "discounted_cash": 735.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST 2 VIEWS", "code_information": [{"code": "73100", "type": "CPT"}, {"code": "5013100", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 205.8, "gross_charge": 980.0, "discounted_cash": 735.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 32.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 32.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 32.6, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 32.6, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 32.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST 3 VIEWS MINIMUM", "code_information": [{"code": "73110", "type": "CPT"}, {"code": "4903110", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 408.45, "gross_charge": 1945.0, "discounted_cash": 1458.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 408.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST 3 VIEWS MINIMUM", "code_information": [{"code": "73110", "type": "CPT"}, {"code": "5013110", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 408.45, "gross_charge": 1945.0, "discounted_cash": 1458.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 408.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 74.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROGRAPHY", "code_information": [{"code": "73115", "type": "CPT"}, {"code": "4903115", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 870.03, "gross_charge": 4143.0, "discounted_cash": 3107.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 870.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 227.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 115.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 115.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 115.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 115.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 115.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROGRAPHY", "code_information": [{"code": "73115", "type": "CPT"}, {"code": "4913115", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 870.03, "gross_charge": 4143.0, "discounted_cash": 3107.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 870.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 227.03, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 115.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 115.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 115.93, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 115.93, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 115.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY", "code_information": [{"code": "29840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29843", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29844", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29846", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29847", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11543.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12826.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 2042.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ENDOSCOPY/SURGERY", "code_information": [{"code": "29848", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 6694.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 3605.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1286.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST REPLACEMENT", "code_information": [{"code": "25446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14407.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 14407.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 5461.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRLS SKN SNR ANISOTROPY MEAS", "code_information": [{"code": "639T", "type": "CPT"}], "standard_charges": [{"minimum": 84.09, "maximum": 4200.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 84.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 84.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WSTNT B ENDOPROS VIATOR", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "8240423", "type": "CDM"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WSTNT B ENDPROS UNISTEP+", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8240435", "type": "CDM"}], "standard_charges": [{"minimum": 2488.29, "maximum": 2488.29, "gross_charge": 11849.0, "discounted_cash": 8886.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 2488.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WSTNT B RP EPROS UNIS+80", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8240442", "type": "CDM"}], "standard_charges": [{"minimum": 1822.8, "maximum": 1822.8, "gross_charge": 8680.0, "discounted_cash": 6510.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 1822.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WSTNT ENTR ENDP UNSTP DS", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "8240420", "type": "CDM"}], "standard_charges": [{"minimum": 3572.73, "maximum": 3572.73, "gross_charge": 17013.0, "discounted_cash": 12759.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "standard_charge_dollar": 3572.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Warfrn or othr antcog no rx", "code_information": [{"code": "G8971", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "X-LINKED INTELLECTUAL DBLT", "code_information": [{"code": "81470", "type": "CPT"}], "standard_charges": [{"minimum": 914.0, "maximum": 914.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 914.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 914.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-LINKED INTELLECTUAL DBLT", "code_information": [{"code": "81471", "type": "CPT"}], "standard_charges": [{"minimum": 914.0, "maximum": 914.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 914.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 119.16, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 53.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE 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[{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY HEAD FOR ORTHODONTIA", "code_information": [{"code": "70350", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 80.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": 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{"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 168.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 85.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL CPLX WO ECP", "code_information": [{"code": "66982", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14311.0, "estimated_discounted_cash": 20112.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12878.0, "methodology": "fee schedule"}, {"payer_name": 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1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL INSJ 1+", "code_information": [{"code": "66991", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14311.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12878.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14311.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL W/ECP", "code_information": [{"code": "66988", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14996.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13496.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL W/O ECP", "code_information": [{"code": "66984", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14311.0, "estimated_discounted_cash": 18478.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 12990.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12878.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14311.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CORVEL", "plan_name": "CORVEL HEALTHCARE CORP WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "PRAXIS HEALTH NETWORK WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART PREFERRED CARE WC", "standard_charge_dollar": 1066.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCM BIOLOGIC TISS MATRIX 1CM", "code_information": [{"code": "Q4142", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCPSL CTRC RMVL CPLX INSJ 1+", "code_information": [{"code": "66989", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14311.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 13594.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12878.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14311.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XENOGRAFT IMPLTJ ARTCLR SURF", "code_information": [{"code": "737T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA US HEALTHCARE", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "AMERICAS CHOICE", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12252.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13614.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "GALAXY HEALTH NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 36.9, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA LEASED NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XK GNOTYP XK EXONS 1-3", "code_information": [{"code": "200U", "type": "CPT"}], "standard_charges": [{"minimum": 274.83, "maximum": 274.83, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XOME TUM & NML SPEC SEQ ALYS", "code_information": [{"code": "36U", "type": "CPT"}], "standard_charges": [{"minimum": 4780.0, "maximum": 4780.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4780.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XRAY ENDOVASC THOR AO REPR", "code_information": [{"code": "75956", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XRAY ENDOVASC THOR AO REPR", "code_information": [{"code": "75957", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XRAY PLACE DIST EXT THOR AO", "code_information": [{"code": "75959", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS PREFERRED PROVIDER ARRANGEMENT", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "plan_name": "COMMONWEALTH CARE ALLIANCE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XRAY PLACE PROX EXT THOR AO", "code_information": [{"code": "75958", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA NARROW NETWORK", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 21.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HIGH PERFORMANCE NETWORK", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS HMO BLUE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS INDEMNITY", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BLUE CROSS OUT OF STATE", 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